Support groups such as the one I attend often encourage fellow sufferers by sharing lists of people with our disorders who were successful. They are the most common explications of the benefits of being mentally ill and I do believe that they are helpful in instilling hope in those who have received diagnoses of bipolar disorder or depression. Thinking of Vincent Van Gogh or Percy Bysshe Shelley may tilt some towards grandiosity and denial, but most people take it to mean that they, too, can be able. Some such as New Age guru Tom Wooten go so far as to claim a “bipolar advantage”.
There’s a problem with this, however, and it is the failure to recognize how much people like Van Gogh and Shelley suffered. Van Gogh committed suicide. Shelley went to his doctors begging them for help with his catastrophic mood swings. In the end, the poet cavalierly ignored warnings of a storm at sea and went sailing anyways: he was found dead on the shores of Italy a few days later, an apparent drowning.
All of us who fight mental illness yearn for acceptance of who we are. None of us seeks the isolation which stigma brings. Comparisons of recovery rates in the industrialized world and the Third World by the WHO show that, one in six in the one and one in three in the latter* recover well enough from their first schizophrenic episode to function. Scientists suggest that the reason for this is less stigma and better family support in the latter. More important, I think, is the level of stress that afflicts one. Western societies are more competitive, more prone to casting off people who are seen as drains on resources. One finds oneself quickly isolated in the West and unless one has strong family support — witness the recoveries of Elyn Saks and Kay Jamison to name two — one may find oneself a prisoner of one’s apartment, denied any job or company.
Romanticists fail to acknowledge the reverse of the figures that they cite: In the West, 85% of those with schizophrenia do not function well enough to return to Society. But in the Third World, this number is still very high: 63%. One should also note that function is defined by one’s ability to hold down a job. In the Third World, there are lots of unskilled jobs for which there is no class stigma. Many who fall victim to mental illness in the West covet more skilled positions that challenge their minds. So at least part of the seeming advantage may be illusory. Telling a lawyer that he can now get a job at Starbuck’s is a lot different from telling a beet farmer that he can go back to being a beet farmer. The resistance of the former to unskilled employment is understandable; they have tasted the financial benefits and the stimulation of intellectual work.
The use of function to define recovery — a product of Western social work — has another problem: it may not indicate remission of symptoms. It is easier to weed your garden than read a legal brief when the voices in your head are shouting at you.
Do people in the Third World really treat the mentally ill better? I often hear schizophrenics say that they would be revered as shamans in the old days. Two things: First, this wasn’t such a great thing. Shamans were pushed out to the fringes. They weren’t respected, they were feared. Second, most people who lived with mental illness didn’t enjoy the luxury of being the Delphic Oracle or the Sybil. Hippocrates, for example, recognized mental illness as a worthy object for treatment. People sought him out for cures; they didn’t want to be afflicted with voices, depression, and mood swings then any more than they do today. If you were mentally ill, the ancients thought you were weird and dangerous. Consider the cases in the Gospels where Jesus is reputed to treat mental illness by casting out demons. The individuals he described were feared and driven away. The demons they carried were thought to be contagious. That’s not a world that I would have liked to live in with bipolar disorder.
Since the 1996 study that I mentioned above, doctors have been taking a second look at the mentally ill in Third World cultures:
Nora Mweemba, who works for the WHO in Zambia, explains that many people suffering from mental health problems don’t come forward for treatment because “communities still regard mental health as a misfortune in the family or some sort of punishment [from God]”. What treatment is delivered tends to rely on traditional healers who often interpret mental illness in terms of possession or curse.
Many countries also lack the basic legal framework to protect those with a disability. Human rights violations of psychiatric patients are common, with patients physically restrained, isolated and denied basic rights. There are therefore significant cultural barriers to overcome to deliver mental health policies.
Another study looked at stigma in Asia. Here the romanticists would have you believe that the mentally ill are treated better than in the West, but the fact is that they are treated worse:
Comparable to Western countries, there is a widespread tendency to stigmatize and discriminate people with mental illness in Asia. People with mental illness are considered as dangerous and aggressive which in turn increases the social distance. The role of supernatural, religious and magical approaches to mental illness is prevailing. The pathway to care is often shaped by skepticism towards mental health services and the treatments offered. Stigma experienced from family members is pervasive. Moreover, social disapproval and devaluation of families with mentally ill individuals are an important concern. This holds true particularly with regards to marriage, marital separation and divorce. Psychic symptoms, unlike somatic symptoms, are construed as socially disadvantageous. Thus, somatisation of psychiatric disorders is widespread in Asia. The most urgent problem of mental health care in Asia is the lack of personal and financial resources. Thus, mental health professionals are mostly located in urban areas. This increases the barriers to seek help and contributes to the stigmatization of the mentally ill. The attitude of mental health professionals towards people with mental illness is often stigmatizing.
So much for the idyllic paradise that the romanticists want you to believe exists in the developing world.
Those who doubt these latter studies will claim that I am merely being a mouthpiece of Big Pharm and the Western medical establishment. These same people, I dare say, are likely to say that an iron ball rolls across a table because of spirits rather than the magnet the medium is using beneath the table. For all of its failures — I will admit that those living with schizophrenia have it harder because of the sledge hammer effects of typical anti-psychotics — Western medicine at least relies on evidence to explain mental illness and devise its cures. I also point out that paranoia, grandiosity, and anosognosia are three hallmarks of mental illness that we should take into account when evaluating anecdotes purporting to profess to cures by alternative “non-Western” medicine or the superiority of the untreated way of life. I don’t trust any report that isn’t supported by evaluations by trained professionals and neither should you.
What we need are well-devised studies. I pointed out the problems with the first study which failed to examine its own standards and adjust for them. Undoubtedly, there are things that people in the developing world do better — in places — that are worth incorporating into our own treatment of the mentally ill. Western medicine has long exhibited a willingness to use effective natural medicine — the design of modern clinical practice, for example, is based on Cherokee medicine. But let’s not be stupid and throw out what evidence has shown us to be effective or true. And let us realize that for every poem, there are many long dark nights of the soul that the sufferer would prefer to be without.
*The percentages are 15 per cent in the one and 37 per cent in the latter. Those championing Third World medicine represent the latter as “1 in 2” which makes me question their ability to do math. Do the calculation yourself: 50 minus 37 is 13 and 37 minus 33 is 4. This is another example of bending the facts to accommodate the dream.