Doctors Tell U.N. of Mental Health Crisis in Developing World

A team of Harvard Medical School doctors turned over a study Monday to U.N. Secretary General Boutros Boutros-Ghali that reports an alarming deterioration of mental health in the developing world, caused largely by age, poverty and violence.

The doctors called the situation “a largely unheralded crisis” and asked the United Nations to put the issue “on the international agenda” by staging a 1996 world summit on mental health.

“There’s a myth that this area of mental health is not all that important,” Dr. Arthur Kleinman, the head of the team, said in a telephone interview. “There’s a myth that we can wait on it and maybe these poor people will become richer and maybe they will grow out of these problems. . . . But these are some of the most compelling human problems of our time.”

Some statistics cited by Kleinman and his associates were startling:

* Sri Lanka has the highest suicide rate in the world, four times higher than that of the United States. Hungary is second to Sri Lanka.

* Children in Malaysia, Bangladesh and Pakistan are two to three times more likely to suffer mental retardation than children in most industrialized countries.

* Epilepsy is three to five times more prevalent in Latin America and Africa than in Europe and the United States.

The secretary general accepted the report and agreed that “the international community must mobilize to address” the psychosocial disorders afflicting developing countries.

The report lists several causes of the problem but spotlights three as most important:

* As a result of recent, enormous medical advances, people live longer in the developing world and thus fall prey to mental illnesses that normally afflict people as they get older.

* A huge wave of violence has engulfed Africa, Asia and Latin America largely as a result of “nationalist movements, ethnic rivalries, political insurgencies and regional disputes,” the report said, with “civilians, rather than soldiers” the most common casualties.

Kleinman said these instances of violence drive up rates of depression and of what is known as post-traumatic stress disorder--a condition where victims of or witnesses to violence have horrible flashbacks, feel numb emotionally, detach themselves from other people and avoid any activity that might evoke bad memories.

* The poverty of cities in the Third World. There has been vast migration from rural to urban areas in the last 40 years or so.

The report, however, says high incidences of stress and depression should be blamed not on the feverish pace of urbanization but instead on the economic status of those experiencing change.