Myth vs. fact: Schizophrenia: across cultures

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Susan grew up in a family of mixed cultural heritage. One parent is Italian, while the other is a combination of English, Irish and German. Growing up, she noticed her parents' responses to illness were very different.

Her father was careful to rest when ill, being nurtured back to health by his wife. Whereas Susan's mother appeared just shy of death before taking to bed, and often, quietly enduring whatever ailed her. As there are cultural differences in response to ill health within family members, so are there cultural differences within our neighborhoods and around the world. Schizophrenia, like other illnesses, has identifiable characteristics in people wherever they live. Yet cultural values and belief systems can shape expressions of and responses to symptoms.

Schizophrenia spectrum disorder is marked by distortions of perception such as hallucinations (seeing, hearing or feeling things that aren't there), delusions (cemented ways of thinking unmoved by conflicting evidence), and/or confusing speech (saying things that don't make sense, or talking or laughing to oneself). Other symptoms include difficulty expressing emotions, and lack of self-care or other disorganized behaviors. The Diagnostic Statistical Manual 5 (DSM 5) requires symptoms to be present for about a month for a person to be diagnosed with schizophrenia.

More than 21 million people throughout the world suffer from this disorder according to the World Health Organization, (April, 2016) and as few as 50% of them receive treatment. Although genetics can play a role in a person developing schizophrenia, culturally contextual stressors are also culprits in its occurrence. Some of the contributing stressful situations described in "Update: Schizophrenia Across Cultures" by Neely Laurenzo Myers, (2011) occur when one lives or goes to school mostly with people of a different ethnicity, or experiencing trauma as a child or adolescent. A review of several studies of people in Western countries showed an increased risk for those living in urban settings.

Myers describes differences in how people make sense of their symptoms. Some areas, such as Mandarin China, will use phrases that are more inclusive and help to decrease stigma. An example is "excessive thinking," which most people can relate to. Other groups of people understand there to be something "abnormal in the brain," but view it as a spiritual issue rather than as an illness.

Anwesha Banerjee, (July 2012) discusses practices of collectivism in some areas of the world possibly contributing to a decrease in symptoms among certain groups of people. Such cultures experience strong family ties and a greater likelihood of people with schizophrenia living at home and working in the family business. This arrangement can produce less social tension. On the other hand, in areas prizing individualism such an arrangement may contribute to low self-esteem.

The timing of the occurrence of symptoms is the same in all cultures. We know men are more likely to show symptoms in their late teens to early twenties, and women's symptoms are more likely to begin in their mid-twenties or later. We know schizophrenia spectrum disorder can be an intense and debilitating illness, robbing some people of important aspects of their life while others can recover to attend school, work, and raise families. We know many individuals find relief with the help of medication and therapy. Treatment plans with culturally sensitive considerations can aid in recovery. Supportive groups run by people who have experienced serious mental illness, such as the Hearing Voices group, can be of value.

We also know more resources are needed to discover more effective treatments to help people with schizophrenia and to potentially decrease health-care spending. The Report to Congress on Medicaid and Chip, (June 2015) concludes people with behavioral health diagnoses account for 20 percent of all enrolled in Medicaid. All medical services included for this twenty percent of people, accounts for almost half of all Medicaid dollars spent.

Science has made tremendous strides with treatment for HIV/AIDS. We need to aim for similar results in the treatment of schizophrenia. The National Institute of Health, Research Portfolio Online Reporting Tools (February 2016) shows almost 12 times the amount of money was spent on research related to HIV/AIDS in 2014, compared to that spent researching schizophrenia. What would the world be like, if we made the same level and rapidity of progress in research with schizophrenia as we have with HIV/AIDS?

Carolyn Sacco, RN has worked as a nurse in psychiatry since 1985, in inpatient hospital, outpatient clinic, and home settings. Jeffrey Geller, MD. MPH is professor of psychiatry at the University of Massachusetts Medical School. He also treats in- and outpatients.


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