To have and to hold: a cross-cultural inquiry into marital prospects after psychosis.

Received wisdom and a substantial body of epidemiological work indicate that early psychosis bodes ill for matrimonial prospects. Using follow-up data from ISoS, the WHO-Collaborative International Study of Schizophrenia, we confirm an earlier local finding that marital success, 15 years after first-break psychosis, is quite favourable in India: 74% for women, 71% for men, compared with elsewhere: 48% for women, 28% for men. This comparative advantage applies to both marriages contracted after onset of psychosis as well as those that survive it, and is the more remarkable for occurring in a culture where the stigma attached to mental illness with regard to marriage is especially heavy. The presence of children and availability of household assistance both appear to enhance odds of successful marriage. That expressed worries about marriage proved so poor a guide to actual performance (and, indeed, survive living proof to the contrary in the families reporting the stigma) suggests that inquiries into stigma should be reworked as larger inquiries into local moral economies of worth. In the dharma-governed world of Hindu India resistance to the cultural opprobrium attached to madness is not a strategic assault on a structured source of shame and discrimination, but a tactical manoeuvre in the name of a higher cultural good - family, the lineage and the social order. Restoring this social basis of self-respect repairs what would otherwise be a disabling breach in the normal maturation process; developmental continuity, in turn, may help explain India's favourable rates of recovery from psychotic disorder. By the same token, the lack of coordinate processes in cultures where transitions to adulthood are poorly marked and post-hospital expectations are low may help to explain the common experience of 'social defeat', and poor outcome, in the lives of former psychiatric patients in the West.