Culture, Stress and Recovery from Schizophrenia: Lessons from the Field for Global Mental Health

Abstract

This cultural case study investigates one U.S. psychosocial rehabilitation organization’s (Horizons) attempt to implement the recovery philosophy of the U.S. Recovery Movement and offers lessons from this local attempt that may inform global mental health care reform. Horizons’ “recovery-oriented” initiatives unwittingly mobilized stressful North American discourses of valued citizenship. At times, efforts to “empower” people diagnosed with schizophrenia to become esteemed self-made citizens generated more stressful sociocultural conditions for people whose daily lives were typically remarkably stressful. A recovery-oriented mental health system must account for people diagnosed with schizophrenia’s sensitivity to stress and offer consumers contextually relevant coping mechanisms. Any attempt to export U.S. mental health care practices to the rest of the world must acknowledge that (1) sociocultural conditions affect schizophrenia outcomes; (2) schizophrenia outcomes are already better in the developing world than in the United States; and (3) much of what leads to “better” outcomes in the developing world may rely on the availability of locally relevant techniques to address stress.

Toward a new architecture for global mental health

“…While diseases resulting from poverty and poor environmental conditions, such as diarrhoea or tuberculosis, have often been "medicalized" (transforming largely social and political problems into narrow biomedical concerns) and subject to massive technological interventions, mental disorders and the newly emerging behaviourrelated problems challenge conventional biomedical solutions and demand a different approach. As shown in carefully conducted studies, the course and outcome of severe mental disorders depend not solely on access to services, medication, skills, and the availability of professional care, but also on the reactions, care, and support provided by family members and the immediate social network of community resources (Adeponle, Whitley, & Kirmayer, 2012;Campbell & Burgess, 2012;Myers, 2010). Likewise, many behaviour-related disorders have no simple, effective, and readily available bio-technological solution, but require changes in individual and collective behaviours as well as interventions directed to both "microsocial processes" and the broader social context (Pedersen, 2012).…”

“Debo tener esquizofrenia tal vez”: experiencia subjetiva y construcción autobiográfica en un adolescente con primer episodio de esquizofrenia

“…Por una parte, la hipótesis del "período crítico" (Birchwood, Todd y Jackson, 1998) ha indicado que el tratamiento durante los 2 a 5 años posteriores al primer episodio psicótico resulta determinante en su pronóstico, es decir, un menor tiempo de psicosis no tratada durante el primer episodio se asocia con un mejor pronóstico (Alvarado, 2005;Baldor, Jerez, Rullas y González, 2008;Ministerio de Salud, 2009;Vallina, Lemos y Fernández, 2006). Por otra parte, los resultados de los estudios longitudinales de seguimiento de los años ochenta y noventa, así como los movimientos de usuarios y familiares de personas con esquizofrenia, han colaborado a la construcción de perspectivas más esperanzadoras sobre su evolución y pronóstico (Myers, 2010). Este nuevo escenario clínico ha favorecido también una ampliación del concepto de recuperación de un episodio psicótico: desde un énfasis centrado en criterios clínicos (disminución de los síntomas) y sociales (desarrollo de relaciones y roles sociales significativos), conceptualizaciones como la de May (2005( , citado en Palma, 2007 consideran que existiría una recuperación psicológica, vinculada específicamente con la comprensión y el proceso de dar sentido a la experiencia psicótica.…”

A Critical Examination of “Morality” in an Age of Evidence-Based Psychiatry

“…As Myers (2010) argues, mental health services researchers might pay attention to what we have learned from studies of serious and persistent mental illness in the ''developing world,'' where schizophrenia and other disorders seem to have a better prognosis. It has been shown, for example, that those in India who are diagnosed with schizophrenia maintain meaningful roles in family life (Hopper 2004).…”