Are Schizophrenia Outcomes Better in Developing Countries?

Award winning medical journalist and author of Anatomy of an Epidemic and Mad In America, Robert Whitaker, became curious when he read about two World Health Organisation studies that showed longer-term outcomes for schizophrenia patients in three “developing” countries were much better than six “developed” countries. Despite limited resources how was it that outcomes for schizophrenia in places like India or Nigeria were better than the US?

Living in Argentina, I have had first hand experience of mental health care in a developing country. There are more psychiatrists in Buenos Aires than anywhere else in the world. At first I thought this was because more people needed them. With their history of military dictatorships still in living memory and the fact that many immigrants have arrived escaping traumatic conditions somewhere else in the world. But now I see that it is because they value talking, psychology and all things mind. It doesn’t carry the stigma that it does in the UK.

This is the image that greets me when I walk into Hospital Rivadavia in Buenos Aires to see a psychologist called Delfina. Delfina means dolphin. I’ve never been offered a talking therapy in the UK and when I asked if it was possible to see a psychotherapist, I was told, ‘No’ and put on a long NHS waiting list to see a counsellor instead. But here in Argentina, even as a foreigner, I’ve been given access to an English speaking psychologist for free! YES FOR FREE!

schizophrenia outcomes

I saw a psychiatrist and a psychologist for an hour a week, as an outpatient. There is definitely more direct contact between patient doctor in Argentina. More quality time had led to a better quality of relationship. Apparently in psychotherapy, the method doesn’t matter so much as the quality or relationship. The psychiatrists I have met also feel more human to me and less professionally distant.

The second time I was here, I got insomnia and struggled to function so I went to hospital to get help. My parents actually paid for me to go into a private clinic so I have experience both public and private care in Argentina. I was put under the care of a lovely man called Salvador, which means saviour. The significance of his names was not lost on me! He saw me every day, for about an hour. He wanted to personally make sure I was OK and improving day by day. He even commented on how my eyes looked better one day, that I looked more present in them. This was because I had a personal trainer who had me on an exercise bike for forty minutes a day. Consultant psychiatrists in the UK attend a ward round perhaps once a week, if you’re lucky.

Salvador said that family was very important in Argentina and he wouldn’t discharge me from the hospital unless I have a family member come for me. He said I was well enough to leave but whilst he was responsible for my care he didn’t feel it was OK to send me off on my own. My mother had to fly from the UK just to get me out.

However, he prescribed lithium for me , which he recommended I take for two years, even though I was not bipolar. It did nothing to prevent another episode.

If you want to recover from schizophrenia in Argentina, without being heavily drugged, then home care is still the only option. My last episode of psychosis was during the pandemic. This provided me with the good excuse not to go to hospital. After all, they needed their resources for the health crisis. I stayed with a friend and her five cats who took good care of me. I spoke to the psychiatrist from the public sector, who I had seen for a total of 18 months, and medication and hospital was all she could offer. When I refused, she actually offered to come to my house and treat me, out of hours and off the books, as a friend. That would certainly never happen in the UK. I was very touched but went the alternative route.

So the short answer is that, perhaps outcomes for schizophrenia are better in the developing world due to a better quality of relationships but they are still depending solely on psychiatric drugs to support someone in crisis.

Recovered and undeterred, I’m back in action to continue to pursue my passion for tango, having found out what works best for me outside of the mainstream medical system.

My debut memoir My Beautiful Psychosis: Making Sense of Madness is published by Aeon Books and is now available as an audiobook on Audible, Amazon and iTunes.


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