CULTURE AND SCHIZOPHRENIA AND OTHER PSYCHOTIC DISORDERS
Section snippets
Definitions of Culture
Culture has been defined in many different ways according to preferences of particular authors. Most, however, regard it as some form of shared learned behavior, handed down from one generation to the next, for purposes of individual and societal growth. These definitions also emphasize an objective (external) aspect consisting of artifacts, roles, and institutions, and a subjective (internal) aspect represented by shared beliefs, attitudes, values, and norms1, 62 Even such comprehensive
CONTRIBUTIONS OF THE WORLD HEALTH ORGANIZATION
Since the 1960s the World Health Organization (WHO) has been conducting a series of multinational, multicentric epidemiologic studies of schizophrenia. These began with twin purposes of gathering information about incidence and prevalence, and formulating a model for cross-cultural epidemiologic research. Three such large-scale international collaborative studies have been conducted.83, 84
Prevalence
A striking feature of studies on prevalence of schizophrenia in different cultures is the similarity of their findings. Prevalence rates of the more reliably conducted studies vary between 1 to 2 per 1000 population. Age specific rates above 16 years are of the order of 4 to 5 per thousand.33 Cross-cultural comparisons have also suggested that the rates do not vary greatly between developing and developed countries.57, 69 Studies from different parts of India have also yielded similar rates of
Initial Comparisons
Historically, till the publication of the work of Murphy and Raman69 it was generally accepted that schizophrenia had similar course and outcome across the globe. These authors from Mauritius were the first to demonstrate an improved outcome and favorable course among indigenous Mauritians, than comparable Western populations. Two subsequent studies, one from Hong Kong,59 and the other from Sri Lanka,106 also found good outcomes in a major proportion of their samples. Contrary findings were,
SOCIOCULTURAL FACTORS AND OUTCOME
The exact nature of social, cultural or environmental factors contributing to the better outcome in developing countries has been the subject of much debate. Effects of industrialization, differences in physical environment or family atmosphere, have all been invoked as responsible factors. No definite conclusions have been reached.
CULTURAL ASPECTS OF TREATMENT
This area has been explored in great depth by all manner of professionals. Volumes have written on the role of traditional healers in non-Western cultures. There are also several hypotheses about how therapeutic processes in indigenous treatments work. Research has shown that cultural beliefs and norms also determine the pathways to care.40 In addition, there is growing body of literature that points to the impact of sociocultural factors on treatment with drugs. Ethnic differences in
ACUTE PSYCHOSES
The existence of transient psychoses, which are neither schizophrenic, nor affective, has been long suspected. The concept has survived under several pseudonyms such as hysterical psychosis, bouffee delirante, reactive psychosis, and so forth.113 Clinical experience and research reports have suggested that this entity is much more frequent in non-Western cultures, where it accounts for a large proportion of psychiatric hospitalizations.87, 88 The IPSS111 and the DOSMeD34, 85 studies were able
A METHODOLOGIC DILEMMA
Theoretic and methodologic issues related to cross-cultural psychiatry have been discussed by several authors.19, 41 Only a brief mention of the outstanding problems is made in this article.
The central conflict in comparative psychiatry across cultures seems to be between its two goals: to demonstrate worldwide equivalence and cultural differences. It has been argued that investigators have too often been influenced by Western concepts of normality and abnormality, and the undue reliance of
SUMMARY
The comparative study of schizophrenia and related disorders across cultures has come a long way since Kraepelin advocated its cause, following his trip to Java at the beginning of the last century. The principal development since then has been the burgeoning of interest in the field, culminating in innovative and ambitious international collaborative research by the WHO. Despite reservations about covert ideology or about the more overt methodologic difficulties, the balance of evidence from
References (116)
- et al.
Post-hospital adjustment of chronic mental patients
Lancet
(1958) - et al.
Cross-cultural issues in the course and treatment of schizophrenia
Psychiatric Clin North America
(1993) - et al.
Positive and negative subtypes of schizophrenia: A follow-up study from India
Schizophr Res
(1990) Does culture make a difference in psychopathology?
Culture and mental illness in an international perspective
Hallucinations and culture
B J Psychiatry
(1995)- et al.
Subsyndromes of chronic schizophrenia: A phenomenological study
Acta Psychiatr Scand
(1997) Life events in schizophrenia. The WHO collaborative study
Soc Psychiatry Psychiatr Epidemiol
(1987)- et al.
Factors in onset of schizophrenia: A comparison between London and Trinidad samples
Acta Psychiatr Scand
(2000) - et al.
The influence of ethnicity and family structure on relapse in first-episode schizophrenia. A comparison of Asian, Afro-Caribbean and white patients
Br J Psychiatry
(1992)
Cross-cultural evaluation of Schneider's first-rank symptoms: a report from the international pilot study of schizophrenia
Am J Psychiatry
Witchcraft beliefs and persecutory ideas in Bengali culture
Indian J Social Psychiatry
Schneider's first-rank symptoms: An international and interethnic comparative study
Acta Psychiatr Scand
Schneider's first-rank symptoms: Their prevalence and diagnostic implications in an Asian population
Br J Psychiatry
Negative symptoms, neurological signs and neurophysiological impairments in 204 Hong Kong Chinese patients with schizophrenia
Br J Psychiatry
Cultural and temporal variations in schizophrenia: a speculation on the importance of industrialization
Br J Psychiatry
WHO collaborative studies on acute psychoses using the SCAAPS schedule
The interface between culture and mental illness in French speaking West Africa
Fever and acute brief psychosis in urban and rural settings in North India
B J Psychiatry
Outcome in schizophrenia and related disorders compared between developing and developed countries. A recursive partitioning re-analysis of the DOSMD data
B J Psychiatry
Methodology in cross-cultural psychopathology
Long term course and outcome of the Agra Cases in the International Pilot Study of Schizophrenia
Acta Psychiatr Scand
Is schizophrenia disappearing?
Br J Psychiatry
The relationship between schizophrenia and immigration: Are there alternatives to psychosocial hypotheses?
Br J Psychiatry
Culture and schizophrenia: the DOSMD challenge
B J Psychiatry
A better outlook for schizophrenics living in extended families
B J Psychiatry
Psychiatric symptoms and diagnosis in two subcultures
Int J Soc Psychiatry
Cross-national differences in the frequency and outcome of schizophrenia: a comparison of five hypotheses
Soc Psychiatry Psychiatr Epidemiol
Correlates of positive and negative schizophrenic syndromes in Nigerian patients
B J Psychiatry
Thirteen-year social outcome among Nigerian outpatients with schizophrenia
Soc Psychiatry Psychiatr Epidemiol
Three syndromes in schizophrenia: validity in young patients with recent onset of illness
Psychological Medicine
Schizophrenia—falling incidence and better outcome?
Br J Psychiatry
Negative symptoms at discharge predict poor outcome in schizophrenia
Br J Psychiatry
Is schizophrenia universal?
Acta Psychiatr Scand
Culture and schizophrenia
Psychological Medicine
Schizophrenia; manifestations incidence and course in different cultures. A World Health Organization ten-country study
Psychol Med
Culture and schizophrenia
Br J Psychiatry
Anthropology, expressed emotion and schizophrenia
Ethos
The meaning of expressed emotion: theoretical issues raised by cross-cultural research
Am J Psychiatry
Deficits of chronic schizophrenia in relation to long-term hospitalization
Br J Psychiatry
Acute and transient psychotic disorder: a 1-year follow-up study
Acta Psychiatr Scand
Anthropology and psychiatry. The role of culture in cross-cultural research on illness
Br J Psychiatry
The chronicity of schizophrenia in North-West India: results of a follow-up study
Br J Psychiatry
Phenomenology of schizophrenic and affective disorders in India—a review
Indian J Social Psychiatry
Positive and negative subtypes of schizophrenia
Acta Psychiatr Scand
Psychiatric manifestations of CATEGO S + schizophrenia
Indian J Psychiatry
Magico-religious beliefs in schizophrenia: A study from India
Psychopathology
Outcome of schizophrenia in a non-industrialized society: comparative study between Bali and Tokyo
Acta Psychiatr Scand
Society, culture and psychopharmacology
Indian J Psychiatry
Patterns of outcome in schizophrenia in Hong Kong
Acta Psychiatr Scand
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Regional differences in treatment response and three year course of schizophrenia across the world
2012, Journal of Psychiatric ResearchCitation Excerpt :The three WHO studies – The International Pilot Study of Schizophrenia (IPSS) (WHO, 1979), the Determinants of Outcome of Severe Mental Disorders (DOSMeD) (Jablensky et al., 1992) and their successor, the long-term (15- and 25-year) International Study of Schizophrenia (ISoS) (Harrison et al., 2001) – all confirmed that patients living in less economically developed regions have better outcomes than those living in more industrialized regions. While the exact nature of socio-cultural factors contributing to this observation has been the subject of much debate (Kulhara and Chakrabarti, 2001), close family support, greater opportunities for social reintegration, and more positive attitude towards mental illness in less developed countries have been offered as possible explanations (Birchwood et al., 1992). Given that most of these studies were conducted 2–3 decades ago, the present study aimed to revisit this issue to investigate whether the geographical differences in the prognosis of schizophrenia are still present today, using the large naturalistic 3-year W-SOHO (Worldwide-Schizophrenia Outpatient Health Outcomes) study conducted in 37 countries across six regions (Northern Europe, Southern Europe, Central and Eastern Europe, East Asia, North Africa and Middle East, Latin America).
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Address reprint requests to Parmanand Kulhara, MD, FRCPsych, FAMS, Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh -160012, India
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Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India