Zhuk Anastasia

Dragomanov National Pedagogical University

The Institute of Corrective Pedagogy and Psychology

Pet’ko Lyudmila, Scientific supervisor,

Ph.D., Associate Professor,

Dragomanov National Pedagogical University (Ukraine, Kyiv)

CULTURE AND SCHIZOPHRENIA

It is almost 100 years ago that the founder of modern psychiatry, Emil Kraepelin, envisaged a new discipline of comparative psychiatry, focussed on ethnic and cultural aspects of mental health and illness. Schizophrenia is a form of psychosis characterized by symptoms such as disordered thoughts, hallucinations, delusions, and social withdrawal. Medical texts from the 1800s described schizophrenia as an illness that typically begins in young adulthood and often becomes a chronic, debilitating condition. Studies indicate that schizophrenia is more common in urban settings than in rural communities. This may be a consequence of the stress associated with urban living, or a result of the fact that people migrate into urban areas to seek treatment [3].

For many people, the symptoms of schizophrenia can be frightening and tragic.  Confusing changes in behavior, complex delusional belief systems, and cold detachment from otherwise engaging members of families may tragically withdraw from society, unable to cope with the manifestations of a chronic and persistent debilitating illness.  Individuals who are just entering adulthood are often struck down by the symptoms of schizophrenia. While it is generally regarded that this illness has an onset in late adolescence, a significant amount of people first manifest symptoms of schizophrenia in middle or even old age. 

The type of onset is significant in the analysis of an individual with schizophrenia.  Adolescent onset may be considered the age range from 10 to 17 years.  Early-adult onset may be considered from 18 to 30 years of age.  Middle-age onset may occur between the ages of 30 to 45 years.  Late-onset may be considered after 45 years of age.  But the exact determination of the onset can be very difficult, as the illness does not suddenly “strike”.  More obvious psychotic symptoms are

preceded by more ambiguous behaviors [4].

Misdiagnosis may often occur as the symptoms of other disorders overlap with schizophrenia.  The developmental pattern of the illness is also very consistent across cultures, with the onset usually occurring when the individual is making the transition into adulthood. The fact that schizophrenia occurs at about the same rate across so many different cultures has led some theorists to propose that it stems from the human tendency to use symbolic communication. In other words, it has been suggested that schizophrenia is a disorder that has evolved along with the human ability to use language. Although the cross-cultural similarities outweigh the differences, there is some evidence that cultural factors affect the course and the pattern of symptoms in schizophrenia [3].

A group of scientists at the World Health Organization studied the differences between schizophrenics in developed and developing countries in an attempt to unravel what role, if any, culture might play in the development of the disease. This study showed that some symptoms of the illness, as well as its prognosis, differed from country to country. The course of the disease was generally more severe in industrialized nations than in developing countries. They stresses that the competitive nature of technologically advanced societies may impede the recovery of schizophrenia patients whose thought processes can be disrupted by the stress associated with the fast pace of industrialized life [3].

Two groups of studies have examined ethnic differences in schizophrenia symptomatology:1) studies conducted on ethnic groups in the United States, 2) international studies based on cross-cultural comparisons between groups fro m developing countries and those from industrialized Western countries. American studies have focused primarily on two group comparisons, African-American and white, and Latino and white. The results of these studies have been inconsistent. For example, the study by Chuet and al. in 1985 that African-American schizophrenia patients exhibited more anger, disorientation, asocial behavior, and hallucinations, while white patients showed more frequent symptoms of irrelevant speech and unsystematized delusions [1, 306].

Schizophrenic patients in Western developed countries showed a higher frequency of depressive symptoms, primary delusions, thought insertion and thought broadcasting, while in non-Western developing countries visual and directed auditory hallucinations were more frequent. The predominance of persecutory delusions and of auditory hallucinations also in non-schizophrenic disorders suggested to African investigators that these symptoms are not necessarily indicative of schizophrenia in persons of African cultural background. That the influence of ethnicity and culture on psychopathology weighs more than geographic proximity, historical relations and racial similarity, became evident in studies which demonstrated significant differences in the symptoms of schizophrenia when comparing patients in Malta and Libya, Japan and China, Korea and China. Ethnic and cultural differences are reflected in the schizophrenic symptom profiles even if the populations adhere to the same religion, as revealed in the findings of a comparative study of patients in Pakistan and Saudi Arabia [2].

Some cultural differences are also apparent in the kind of delusions that occur in schizophrenia patients. Often, the delusions tend to reflect the predominant themes and values of a person's culture. For example, in Ireland, where religious piety is highly valued, patients with schizophrenia often have delusions of sainthood. In industrially advanced countries like America, patients' delusions tend to focus on sinister uses of technology and surveillance. Patients may report that they are being spied on by their televisions or that they are being X-rayed when they walk down the street. In Japan, a country that prizes honor and social conformity, delusions often revolve around slander or the fear of being humiliated publicly. In Nigeria, where mental illness is believed to be caused by evil spirits, delusions may take the form of witches or ancestral ghosts. Interestingly, many behaviors that would be seen as schizophrenic symptoms in the Western world are considered signs of spiritual exaltation in developing countries. A person who claimed that he was a god on earth would be considered delusional in Western society, but in India, he might be considered a spirit medium who is the human incarnation of a Hindu god. Similarly, in some African cultures, hallucinations are not necessarily seen as a sign of mental illness. Shamans, tribal priests who act as intermediaries between the natural and spiritual worlds, are deeply respected for their ability to describe their experiences in the supernatural realm [3].

It is interesting to notice, that cultural-bound syndromes occur in European cultures as well. The scientists note that in France, bouffée délirante, is marked by transient psychosis with elements of trance or dream states. In Spain and Germany, involutional paraphrenia, refers to a paranoid disorder that occurs in midlife and has features of, yet is distinct from schizophrenia, paranoid type. Cultural bound syndromes that share features of schizophrenia include: amok, marked by a sudden rampage, usually including homicide and suicide, ending with exhaustion and amnesia (documented in Southeast Asia and Malaysia); colera, marked by violent outbursts, hallucinations, delusions, and temper tantrums (documented in Guatemala); and latah, marked by automatic obedience reaction with echopraxia and echolalia (documented in Southeast Asia, Malaysia, Bantu of Africa, and Ainu of Japan) [2].

Professor W. Jilek points out among the socio-cultural factors that have been identified by various researchers as in general of negative influence on the prognosis of schizophrenia, we can cite here those that appear peculiar to Western societies in their present development, namely: Extreme nuclearization of the family and therefore lack of support for mentally ill members of the kin group; covert rejection and social isolation of the mentally ill inspite of public assertions to the contrary; immediate sick role typing and general expectation of a chronic mental illness if a person shows an acute psychotic reaction; and the assumption that a person is insane if beliefs or behaviour appear somewhat strange or "irrational"; further, the unclear and uncertain role expectation of the young in Western societies [2].

Bibliography

1. Brekke John S., Concepcion Barrio. Cross-Ethnic Symptom Differences in Schizophrenia:The Influence of Culture and Minority Status / Schizophrenia Bulletin, 1997. – 23(2). – PP. 305–317. [Web site]. – Access mode: http://schizophreniabulletin.oxfordjournals.org/content/23/2/305.full.pd

2. Jilek Wolfgang G. Cultural Factors in Psychiatric Disorders [Web site]. – Access mode: http://www.mentalhealth.com/mag1/wolfgang.html

3. The Teenage Brain. Culture and Schizophrenia [Web site]. – Access mode: http://www.pbs.org/wnet/brain/episode3/cultures/index.html

4. Versola-Russo Judy M. Cultural and Demographic Factors of Schizophrenia [Web site]. – Access mode: http://www.psychosocial.com/IJPR_10/Cultural_Demographic_Factors_of_Sz_Russo.html