Das et al (Reference Das, Saravanan and Karunakaran2006) assessed the efficacy of interventions to change explanatory models of schizophrenia among relatives of people with schizophrenia in India. They claim that their educational intervention presented the biomedical model without dismissing non-biomedical models and that indigenous beliefs were not challenged. Depending on the way in which the intervention was delivered, one can argue that presenting biomedical models is in itself directly challenging to indigenous beliefs. Although the authors found that their educational programme significantly reduced the number of non-biomedical beliefs, this does not say anything about the quality or depth of these beliefs. Moreover, the description of participants' beliefs as ‘persistent’ and ‘resistant’ suggests that the authors consider holding alternative explanatory beliefs to be problematic. They further justified their aim by suggesting that holding indigenous beliefs contributes to a poor outcome, which they defined as not recognising a biomedical explanation of schizophrenia and not adhering to medication. This is circular logic, using a very limited construction of outcome.
Despite citing a paper by Angermeyer's German research team, Das et al miss their important and consistent finding that biomedical causal beliefs are significantly related to negative attitudes (e.g. Reference Angermeyer and MatschingerAngermeyer & Matschinger, 2003). Such negative consequences of holding biomedical causal beliefs have been found in numerous countries among the public, relatives and patients with severe mental illness (Reference Read, Haslam, Read, Bentall and MosherRead & Haslam, 2004; Reference Read, Haslam and SayceRead et al, 2006).
How does exporting the beliefs of Western experts to low- and middle-income countries fit with the consistent finding that these countries have much better outcomes for ‘schizophrenia’ than Western countries (Reference Harrison, Hopper and CraigHarrison et al, 2001)?
Finally, Das et al recommend that the advantages of medication should be discussed without dismissing or challenging indigenous explanatory models. We cannot assume that the challenge is not inherent in the underlying principles of the belief systems themselves. Investigating ways in which biomedical explanations can be discussed in conjunction with cultural beliefs is a constant challenge that will not be helped by reducing the prevalence of one set of beliefs.
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