The Theory of Industrial Society and Cultural Schemata: Does the Cultural Myth of Stigma Underlie the WHO Schizophrenia Paradox?

摘要

The “Better Prognosis Hypothesis” stems from World Health Organization studies known as the International Studies of Schizophrenia (ISoS). Despite greater availability and sophistication of treatment options in the West, schizophrenia appears to have a more benign course and better outcomes in “developing” societies. We focus on this finding's most common corollary: a simplified version of sociological notions of cultural reality shaped by the transition from agrarian to industrial society. Developing societies are viewed as traditional, gemeinschaft cultures that neither develop nor endorse stigmatizing attitudes and beliefs about persons with mental illness that exist in modern, gesellschaft cultures of developed societies. Using the Stigma in Global Context-Mental Health Study (SGC-MHS), we formalize the “Cultural Myth of Stigma,” propositions linking level of development to intolerant, exclusionary, and individualistic attitudes. In 17 countries, we find no support for the corollary. Where significant associations are documented, the findings are opposite expectations: the public in more developed societies reports lower stigma levels. Extensions to reconceptualizations of the cultural landscape also reveal null or contrary findings. This correction to nostalgic myths of cultural context in developing societies thwarts misguided treatment, policy, and stigma-reduction efforts.