There’s a remarkable scene in the film Medicine at the Crossroads: Disordered States (a BBC TV documentary examining the way different cultures care for people with psychiatric illnesses like schizophrenia) showing a doctor’s waiting room in India. The small room is packed with nearly a dozen chairs filled with family members who have gathered to see a doctor and discuss the treatment of a relative with schizophrenia.
It’s a poignant display of the kind of strong family support people with schizophrenia can expect in India – where it is well documented by the World Health Organization among others, that individuals with schizophrenia live better lives than their North American counterparts.
While schizophrenia does carry a stigma in the broader Indian society (some people think schizophrenia is contagious), schizophrenics are accepted by family members and often by members of their local community. They retain roles and status in their families and they may even marry.
WHO Says Family Support Makes Course of Schizophrenia Better in Non-Western Countries
The World Health Organization’s research shows that the course of schizophrenia differs cross-culturally. And some may be surprised to learn that a better course is usually observed in non-Western societies like India – where treatment of the disease is often radically different form North American medical, institutional models.
Experts warn against over-simplification but it is becoming increasingly clear that a supportive family plays a vital role in helping schizophrenics.
“No matter how good their medical treatment may be, if [a patient with schizophrenia] is sent out of the hospital to be alone, they’re never going to do as well as with a family that’s concerned, that will look after them, that will make sure the doctors do what they’re supposed to do,” says Dr. Jack Gorman, from the New York State Psychiatric Institute, speaking in the documentary Disordered States.
In India, Extended Families Ease the Burden of Caring for Schizophrenic Relative
Montreal professor and anthropologist Dr. Ellen Corin has studied in South India. She says it’s vital to note the cultural differences allowing Indian families to better tolerate the condition. One fundamental difference is the size of Indian families – where extended families come together to care for a schizophrenic relative, greatly easing the burden carried by immediate family members.
Dr. Robert Zipursky, Toronto Centre for Addiction and Mental Health's (CAMH) Clinical director of Schizophrenia and Continuing Care Program says North America has come a long way from the 50s and 60s, when it was a commonly believed that families actually caused schizophrenia.
Zipursky says a schizophrenic patient's future is extremely variable and while a supportive family is helpful, the lack of family support does not equate to a dire prognosis for a patient. However, there is research that shows a highly critical family can negatively affect a patient’s experience.
Families may play an increasingly prominent role in treatment, but the main focus in North America, according to CAMH research scientist and anthropologist Dr. Anneke Rummens, is on the biological explanation and treatment for schizophrenia. Rummens points out that in some ways, a biological explanation is useful because it can be a relief for family members and the patient.
A medical explanation removes blame. This is similar to the case India, where many subscribe to the idea that karma has dictated the fate of the individual with schizophrenia – and no one is to blame.
In North America, People with Schizophrenia Identified Only by their Illness
The flip side, according to Rummens, is that North American society tends to identify people only by their illness. Rummens explained, “It is as though the person is pulled out and marked defective and plucked out of a whole set of relationships. They’re accorded the sick role and that is it.”
Corin points to one remarkable characteristic of Indian families – they have ability to retain a positive image of the schizophrenic individual, despite the negative behavior associated with the disorder.
“It was very moving and very astonishing to see the extent to which they’re able to say, in face of very severe illness, something like ‘this is my brother, he is caring and with a good sense of humor and he loves his family," according to Corin.
Corin says that at this point, what can be learned from cross-cultural analysis, is the value of the holistic approach. It is very important, she says, to consider the impact of families, communities, religion, spirituality, living situations AND medication upon someone with schizophrenia. Together these things affect an individual's experience of schizophrenia and the way that society experiences the individual.
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