Is Schizophrenia Affected by Culture?

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Abstract

Schizophrenia is a mental disorder that results in fake beliefs and hallucinations, they might be auditory, visual or even gustatory hallucinations where this disease is usually targeting adults, men tend to be diagnosed at a younger age than women, it causes difficulty in social interacting as patient lacks motivation and loses ability to form facial expressions also, their emotions and concentration are negatively impacted by the disease leading to their sentences to be complicated and one might not be able to understand them, disturbed sleeping patterns and anxiety are also common symptoms, the patient is mostly in denial or unaware of their condition (Newman, 2017)& (Hurley, 2019).

Some scientists state that cultural beliefs affect the symptoms shown by schizophrenic patients which is convincing as the hallucinations and delusions are originating from the brain so they will be affected by the person’s thoughts that are mostly related to the person’s culture however, my paper will continue research to check for the presence of a link between culture and schizophrenia. Some may experience violent voices others may believe that they are a religious figure and it depends on the patients’ origin and beliefs. This issue will be discussed from a range of perspectives, global one from China, USA and India, national one from Egypt’s point of view and the local one.

Global perspectives

India:

In India it is believed that a patient’s cultural beliefs affect their schizophrenia symptoms as it is a disease in mind, the auditory hallucinations are heavily affected, Indians mostly value their families and collectivism therefore leading to the patients hearing the voices of family members, friends or partners (Davis, 2019). The voices heard among patients were mostly positive and some described them as intimate, they behave as if they care about the patient by guiding them and lecturing them, even though some people may not be fond of them, they still think of them as personal relationships as they do not need to go out to have someone to talk to as they have them by their side whenever they need (Robb, 2014). When patients were asked how they would describe the voices, most used the words entertaining, magical or interesting, very few Indians faced threatening or violent voices compared to other cultures leading to the fact that they do not describe the voices or see them as a sign of illness or troubled mind but are comfortable with them (Parker, 2014). Two tests were made on patients, the first one was reading the emotions on faces of people, Indian patients found it harder to read emotions on faces of people from other races, the second test they were shown faces and were asked to sympathize with their emotions, patients responded less negatively to sad pictures but noticeably more positively to happy pictures proving that ethnicity affect emotional reading in schizophrenia (Lundbeck Institute Campus, 2016). It is also common that patients cover their illness in fear of abandonment or not being married because marriage in India is a necessity that it is even arranged by elders before adulthood (Loganathan & Murthy, 2011). Therefore, Indians overall are positive about their symptoms as their cultural beliefs and lifestyle allows them to hear friendly voices unlike other cultures which proves that culture has an effect on the disease.

USA:

USA shows various signs that prove that culture does in fact affect schizophrenia. Symptoms of the disease are not the only thing affected by culture, in fact the whole process of people at risk of developing the disease more than others, research found that in USA, African Americans are five times at higher risk of developing schizophrenia rather than a simpler brain or mood disorder in relation to Caucasian Americans (Lundbeck Institute Campus, 2016). The process that occurs after being diagnosed with schizophrenia in USA differs from other countries as they mostly face negative symptoms than positive for starters they believe in thought addition and removal, these are hallucinations about not having the ability to command your thoughts, in thought addition the patient gets the false impression that a person or a thing put thoughts in their head, for thought removal it is quite the opposite where the patient believes that someone removed thoughts out of their head (Davis, 2019). Americans tend to refer to their auditory hallucinations using medical terms and psychiatric unlike other countries that refer to them as people and relationships as they mostly encounter violent and aggressive voices and most of the time they were unaware about they were having a conversation with, according to the research deducted, 70% of the patients heared people ordering them to injure themselves or others in messed up and extremely violent ways even worse than those seen in movies, the cause of this is thought to be that Americans see them selves as independant individuals pushed by self identity (Parker, 2014) & (Robb, 2014) & (Khazan, 13). Some doctors treat the voices as useless products of the disease which should be neglected, the differences between voices heard across cultures led to the realization that the way people focus on their voices affects what they hear (Parker, 2014). Also in visual hallucinations it is shown that westerners focus mainly on the objects in the image rather than its background as their culture mainly focuses on the information provided and not the back story of how it came to be (Lundbeck Institute Campus, 2016). USA further confirms the link between the two variables.

China:

China is another country who furthermore supports the claim that schizophrenia is in fact affected by culture. It is believed that people’s hallucinations and delusions originate from fears and worries that are related to their culture, in China people value family and reproduction so the main fear is loss of fertility by ascendance of the penis into the abdomen which is a medical state where the penis is present but hidden in the skin of abdomen (Lundbeck Institute Campus, 2016). Also, visual hallucinations differ in China where the schizophrenic person relates and focuses their attention more to the images background than the objects found in the image as their culture focuses on the backstory of the information provided rather than the information itself which will most likely lead to kinds of hallucinations that differ than other countries who focus on objects in image instead like USA (Lundbeck Institute Campus, 2016). When experiencing voices Chinese patients will be able to know the person they are speaking to as it is believed outside the west that people’s minds are intertwined together through relationships leading to hearing mostly familiar voices (Parker, 2014). It is also shown that non westerners do not have a strong ability to differentiate between real life and imagination unlike other cultures which might be due to the fact that the voices they hear are familiar to them same as the visual hallucinations therefore might report many hallucinations while some might be real life incidents which is a result of their culture as it doesn’t occur in other cultures which furthermore supports my claim (Larøi, et al., 2014).

National perspective

Egypt:

Egyptian culture doesn’t affect symptoms of schizophrenia however it affects the diagnosis of the disease itself. In Egypt, consanguineous marriages are common and study has found that this has a very noticeable effect on schizophrenia, offspring that come from blood related parents are at higher risk of developing schizophrenia than children of non-consanguineous marriages therefore leading to studies showing that it’s mostly common that schizophrenia patients in Egypt are related even through distant family ties specially in the Nile Delta region, as research showed that consanguineous marriages do not only cause genetically complex disorders but also, mental disorders schizophrenia included (Mansour, et al., 2011).To conclude, culture and its beliefs affect schizophrenia in more than one way, affecting the symptoms faced is one way but it can also affect the diagnosis of the illness from the start.

Local perspective:

For the local perspective I interviewed ten people including family and friends but I decided to start off with interviewing my biology teacher as she might have more background on the topic according to her studies however, she did not provide me with the answer expected as she agreed that culture has an effect but was not able to provide reasons and evidence for her opinion so, I started interviewing family and friends. The higher percentage stated that they don’t believe that culture has an effect as it is a disease so, is the same wherever the patient is just like any other illness. The few who believed that there is a link between the two variables had very similar reasons most of them being that it is a disease in the brain therefore, if a person has certain beliefs which are usually a result of different cultures, the voices they hear will be related to their beliefs which is similar to opinions provided by the different countries stated above. One noticeable fact is that most people state their opinion that is not based on any knowledge but, personal opinions which shows lack of education about a serious mental illness.

Personal perspective

Originally before conducting my research I was rather confused and had different opinions surrounding the link between schizophrenia and culture, half of my mind supported that it does in fact have an effect due to different voices heard so, if a person does not have close family or friends they probably will not hallucinate about familiar voices as they do not hear them often. However, another part of me believed that it is not affected by the origin of the person as it is a disease and diseases have the same symptoms and medications worldwide so, i could not think of a reason why this specific disease would differ than others. This research aided me into deciding which part of me was true and that is that there is a large effect of culture on the disease due to different sources used which are written by professionals in the field and supported by evidence and provided experiments and statistics which resulted in more reliable information to help me understand more the effect of culture on the symptoms faced.

Problems and solutions

The most significant problem faced was the fact that after conducting a primary research for the local perspectives, the majority of the people were found to be unaware about the disease itself which leads to troubles as anyone might be subject to this disease so, without the right knowledge, the patient might experience worse symptoms due to incorrect method of dealing with the disease. This was not shown in the global or national perspectives as reliable sources were used so, were written by professionals but, other than professionals many people were uneducated about the topic and to solve this, medical actions like awareness campaigns might be raised in order to spread information about the disease and how to deal with it.

After the sources proved the link between culture and the disease, some countries face violent and negative symptoms unlike others as in the global perspectives so, in order to prevent the negative symptoms to enhance the patients’ experiences, the aspects that provide positive symptoms could be studied by therapists so that they could be introduced into countries with negative symptoms so that future generations do not face the troubles that patients faced in older generations.

One drawback was that i was not able to write more into visual hallucinations and was more focused on auditory ones due to the lack of reliable sources to use to get into this information which made it difficult to search through all aspects of the disease which might be solved by primary research by interviewing professional psychologists to collect the needed data but i was not able to do so because i do not have access to professionals so would not have been able to collect the true and reliable facts to use.

Bibliography

Davis, M. (2019, july 18). Schizophrenia Here Is Different Than Schizophrenia There — Why? Retrieved from bigthink: https://bigthink.com/mind-brain/schizophrenia-by-culture
Hurley, K. (2019, july 17). schizophrenia:DSM-5 definition. Retrieved from https://www.psycom.net/schizophrenia-dsm-5-definition/.
Khazan, O. (13, july 23). When Hearing Voices Is a Good Thing. Retrieved from theatlantic: https://www.theatlantic.com/health/archive/2014/07/when-hearing-voices-is-a-good-thing/374863/
Larøi, F., Bell, V., Luhrmann, T. M., Christian, W., Deshpande, S., Fernyhough, C., et al. (2014, june 13). Culture and Hallucinations: Overview and Future Directions. Retrieved from academic.oup: https://academic.oup.com/schizophreniabulletin/article/40/Suppl_4/S213/1874317
Loganathan, S., & Murthy, S. (2011, december 7). LIVING WITH SCHIZOPHRENIA IN INDIA: GENDER PERSPECTIVES. Retrieved from ncbi: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3233233/
Lundbeck Institute Campus. (2016, june 1). Schizophrenia Across Cultures. Retrieved from institute.progress: https://institute.progress.im/en/content/schizophrenia-across-cultures
Mansour, H., Fathi, W., klei, L., Wood, J., Chowdari, K., Watson, A., et al. (2011, july 1). Consanguinity and increased risk for schizophrenia in Egypt. Retrieved from ncbi.nlm.nih: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2900407/
Newman, T. (2017, December 7). understanding the syptoms of schizophreia. Retrieved from https://www.medicalnewstoday.com/articles/36942.php.
Parker, C. B. (2014, july 16). Hallucinatory ‘voices’ shaped by local culture, Stanford anthropologist says. Retrieved from news.stanford: https://news.stanford.edu/2014/07/16/voices-culture-luhrmann-071614/
Robb, A. (2014, august 8). An Anthropologist Asked Schizophrenics Around the World to Describe the Voices in Their Heads. Retrieved from newrepublic: https://newrepublic.com/article/119017/schizophrenia-experience-and-symptoms-differ-between-cultures

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