Hacker News Reader

Comment by Alex3917 | Hacker News Reader

"The author is wrong, and I'm sorry for that, but it's very unlikely that his son would have ever been a contributing member of society."

In many less developed countries people with schizophrenia have better outcomes. It's only in the US where the condition is usually debilitating for life, because:

A) The US healthcare system relies on longterm use of anti-psychotic medication as the main form of treatment, which tends to lead to worse outcomes in the long run.

B) Family relationships in the US are generally not conducive to properly recovering from schizophrenia.

In other countries the people aren't completely normally, but they're also generally not completely unable to hold a job for their entire lives like in the US.

View on HN

Can you elaborate? Are you saying in other countries the family/extended family generally care for the individual? Why are they more likely to hold down a job?

"Are you saying in other countries the family/extended family generally care for the individual?"

Schizophrenia is basically triggered & exacerbated by stress. If one becomes schizophrenic then it's possible to mostly recover from psychosis in low stress environments, but in higher stress environments it basically becomes permanent.

I think that Ethan Watters discusses why it is that people in poor countries do better due to social factors in his book Crazy Like Us, and Robert Whitaker discusses the role of anti-psychotics in Anatomy of an Epidemic.

In terms of social factors though, I vaguely remember that in poor countries families are more likely to let people with schizophrenia just hang out and work on recovering for years at a time, whereas in more developed countries this is less likely to happen. (Possibly because this isn't as possible due to the higher costs of living and the greater stresses of living in a society with a very unequal distribution of wealth, but I forget the exact mechanism.)

As for the basic data, here is one book that summarizes it:

http://ajp.psychiatryonline.org/article.aspx?articleid=98965

The stress trigger remains an unproved theory - there are other many potential explains (vitamin D, parasites, sociological baed on family dysfunctions...) but so far there is not a good fit.

Outcome from schizophrenia is routinely better in developing world settings, and this difference becomes apparent during the initial 2 years of illness. But even for developing world patients with a poor early course, outcome is superior to that of developed world patients with an equivalent early course. Employment rates are substantially greater for developing world subjects, and some authors have attributed this to the freedom from the economic disincentives to employment that can accompany the provision of disability benefits in the industrial world (1).

In the UK we have something called the Sainsbury Centre for Mental Health.

They provide evidence based advice. They've provided some advice about getting people with mental health problems who are claiming incapacity benefits off benefits and back into work.

The traditional response is a long slow curve; don't rush anything; work is stressful; start with a bit of part time voluntary work; build that up; there aren't enough jobs around anyway and no-ones going to employ mentally ill people and the stress of rejection is harmful. They also used to have a stock of low grade jobs (shelf filling at supermarkets) so when people turned up they'd get kludged into whatever was available.

The evidence shows that many people actually want to be much more active. We now have strong anti-discrimination laws. And "place then train" (get someone a job that they want, then support them to keep that job) is much more effective. If someone is a good employee an employer probably wants to keep them on, and if there's funding available to make reasonable adjustments then letting them know is good.

Here's a list of the Sainsbury Centre publications

(http://www.centreformentalhealth.org.uk/publications/publica...)

I'd be very surprised if this were true. Care to elaborate?

Reply on news.ycombinator.com