Schizophrenia 01 Jun, 2016 Read Time: 4 mins

Schizophrenia across cultures

In November 2014, Cyril Höschl gave a presentation at the Lundbeck Institute on ‘Psychiatry and Culture - Understanding mutual relationships’. Professor Höschl, director of the National Institute of Mental Health in Klecany, Czech Republic, highlighted the influence of culture and society on psychiatry.

Psychiatry has long struggled to find a biological base on which to generate explanatory models of psychiatric disease, including schizophrenia, that are applicable across cultures. The discovery of effective psychopharmaceuticals and advances in functional neuroimaging show that aspects of psychiatry do have a clear biological basis. But, psychiatry, and indeed medicine in general, can only be fully understood when considered within the context of the culture in which it is practised.

Human beings and their reality are socially constructed

Socio-cultural factors relate to psychiatry by:

  • influencing the pathogenesis and symptomatology of psychiatric illness

  • influencing our response to it

  • underpinning and legitimising psychiatric and other interventions.

Psychiatry and culture - understanding mutual relationships

References

  1.   Sartorius N et al. Early manifestations and first-contact incidence of schizophrenia in different cultures. A preliminary report on the initial evaluation phase of the WHO Collaborative Study on determinants of outcome of severe mental disorders. Psychol Med. 1986;16(4):909-28.

  2. Jablensky A et al. Schizophrenia: manifestations, incidence and course in different cultures. A World Health Organization ten-country study. Psychol Med Monogr Suppl. 1992;20:1-97.

  3. Bauer SM et al. Culture and prevalence of hallucinations in schizophrenia. Compr Psychiatry. 2011;52(3):319-25.

  4. Brekke JS et al. Cross-ethnic symptom differences in schizophrenia: the influence of culture and minority status. Schizophr Bull. 1997;23(2):305-16.

  5. Habel U et al. Emotional processing in schizophrenia across cultures: Standardized measures of discrimination and experience. Schizophr Res. 2000;42(1):57-66.

  6. Barnes A. Race, schizophrenia, and admission to state psychiatric hospitals. Admin Policy Ment Health. 2004;31(3):241-52.

  7. Schofield P et al. Ethnic isolation and psychosis: re-examining the ethnic density effect. Psychol Med. 2011;41(6):1263-9.

  8. Zammit S et al. Individuals, schools and neighbourhood: a multilevel longitudinal study of variation in incidence of psychotic disorders. Arch Gen Psychiatry. 2010;67(9):914-9.

  9. Lewis-Fernández R. The cultural formulation. Transcult Psychiatry. 2009;46(3):379-82.

  10. March D et al. Psychosis and place. Epidemiol Rev. 2008;30:84-100.

  11. Wicks S et al. Social adversity in childhood and the risk of developing psychosis: a national cohort study. Am J Psychiatry. 2005;162(9):1652-7.

  12. Wicks S et al. Social risk or genetic liability for psychosis? A study of children both in Sweden and reared by adoptive parents. Am J Psychiatry. 2010;167(10):1240-6.

  13. Corcoran C et al. Effect of socioeconomic status and parents’ education at birth on risk of schizophrenia in offspring. Soc Psychiatry Psychiatr Epidemiol. 2009;44(4):265-71.

  14. Wykes T et al. Diagnosis, diagnosis, diagnosis: towards DSM-5. J Ment Health. 2010;19(4):301–4.

  15. Bourque F et al. A meta-analysis of the risk for psychotic disorders among first- and second-generation immigrants. Psychol Med. 2011;41(5):897-910.

  16. Kirkbride JB et al. Incidence of schizophrenia and other psychoses in England, 1950-2009: a systematic review and meta-analyses. PLoS One. 2012;7(3):e31660.

  17. Werbeloff N et al. Elaboration on the association between immigration and schizophrenia: a population-based national study disaggregating annual trends, country of origin and sex over 15 years. Soc Psychiatry Psychiatr Epidemiol. 2012;47(2):303-11.

  18. Veling W. Ethnic minority position and risk for psychotic disorders. Curr Opin Psychiatry. 2013;26(2):166–71.

  19. Zandi T et al. First contact incidence of psychotic disorders among native Dutch and Moroccan immigrants in the Netherlands: influence of diagnostic bias. Schizophr Res. 2010;119(1-3):27-33.

  20. Aneshensel CS et al. (eds): Handbook of the Sociology of Mental Health.1st ed. New York: Springer; 1999.

  21. Thornicroft G. Shunned: Discrimination Against People with Mental Illness. New York: Oxford University Press; 1996.

  22. Thornicroft G, et al. Global pattern of experienced and anticipated discrimination against people with schizophrenia: a cross-sectional survey. Lancet. 2009;373(9661):408-15.

  23. Linhorst DM. Empowering People with Severe Mental Illness: A Practical Guide. New York: Oxford University Press; 2006.

  24. Trupin L. et al. Trends in Labor Force Participation among Persons with Disabilities, 1993-1994. Washington DC: United States Department of Education, National Institute on Disability and Rehabilitation Research, 1997.

  25. Raboch et al. Use of coercive measures during involuntary hospitalization: findings from ten European countries. Psychiatr Serv. 2010;61(10):1012-7.

  26. Kališová L, Nawka A, Raboch J & EUNOMIA group, WPA, Prague 2012.

Key references and descriptions:

The four papers listed below provide evidence to support the premise that different cultures and races manifest symptoms of schizophrenia differently. Thus, when making a diagnosis of schizophrenia it is important to take into consideration the patient’s cultural and social background.

Sartorius N et al. Early manifestations and first-contact incidence of schizophrenia in different cultures. A preliminary report on the initial evaluation phase of the WHO Collaborative Study on determinants of outcome of severe mental disorders. Psychol Med. 1986;16(4):909-28.

Bauer SM et al. Culture and prevalence of hallucinations in schizophrenia. Compr Psychiatry. 2011;52(3):319-25.

Brekke JS et al. Cross-ethnic symptom differences in schizophrenia: the influence of culture and minority status. Schizophr Bull. 1997;23(2):305-16.

Habel U et al. Emotional processing in schizophrenia across cultures: Standardized measures of discrimination and experience. Schizophr Res. 2000;42(1):57-66.