one suspects, might have made a fine defense attorney. He has certainly shown a willingness to expend a great deal of effort on what many would consider a weak case. Most judges, I believe, would conclude that outcome from schizophrenia has been proved by clear and convincing evidence to be substantially better in the Third World than in the West. Virtually every Third World outcome study points to this conclusion. Third World samples that reveal a substantially higher recovery rate in schizophrenia than is typically seen in Western studies include Mauritius (Murphy and Raman 1971); Hong Kong (Lo and Lo 1977); Chandigarh, India (Kulhara and Wig 1978); Sri Lanka (Waxier 1979); Agra, India; Ibadan, Nigeria; Cali, Colombia; Taipei, Taiwan (WHO 1979); and a sample drawn from five Third World settings for the WHO Collaborative Study on Determinants of Outcome of Severe Mental Disorders (Sartorius et al. 1986).
I can find only one example of an outcome study which fails to support the general finding. In 1957, Dr. J. De Wet, the physician superintendent of a South African mental hospital run along traditional and somewhat restrictive Western lines, concluded that recovery from schizophrenia was no more frequent among his Bantu patients than among Europeans. The hospital treatment, however, appears to have been somewhat restrictive and not particularly conducive to recovery. Many patients stayed in hospital for over a decade; others received 15 to 30 electro-convulsive treatments and were detained for months following treatment to "ensure that sudden relapses did not take place at home" (1957: 745). By contrast, anecdotal reports (Laubscher 1937;Simons 1958) describe excellent recovery from schizophrenia-like psychoses among the Bantu in their own communities. De Wet's report might be seen as a good advertisement for community treatment of schizophrenia (rather than institutional care) or it may describe a select population of more chronic, poor outcome cases who ended up in hospital because they failed to recover in their own community.
The scale of the difference in recovery rates in schizophrenia between the Third World and the West is so great that it must compensate for minor concerns about methodology. An average figure for complete symptom-free recovery from first-break schizophrenia in European and North American studies since 1956 is 22% (Warner 1985): the equivalent figure from the Mauritius study is 64% at 12-year follow-up (Murphy and Raman 1971). On average, 45% of Western first-break schizophrenic patients recover to a level of unimpaired or