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Culture
and the Individual
Schizophrenia
Schizophrenia
Symptoms
Delusions
Hallucinations
Thought confusion
Flattened or inappropriate affect
Withdrawal into fantasy world
Purposeless excited motor behavior not
explained by external stimuli
Not reported in ancient or medieval literature
May be chronic and long term
May occur in a single or in repeated episodes
Delusional Content
• Delusions affected significantly by culture,
with familiar items, people, beliefs and
events part of delusions
• Must know about cars, electricity, robots
for them to be part of delusions
International Study
• Cross-cultural study of nine countries
Colombia, Czechoslovakia, Denvark,
India, Nigeria, Taiwan, United Kingdom,
US, USSR
Found relatively consistent symptoms of
schizophrenia across patients
Symptoms were evaluated using etic
criteria.
Barrett
• The Iban, Sarawak, Borneo, Malaysia
• A comparison of First Rank Symptoms
(FRS) between the Iban and Australians
• An analysis of the effect of cultural models
on symptoms
• Issues of
– Translation
– Language
– Culture
Barrett
First Rank Symptoms of Schizophrenia
*Audible thoughts
Voices arguing
Voices commenting on one’s actions
*Thought insertion or thoughts ascribed to others
*Thought withdrawal
*Diffusion or broadcasting of thoughts
Impulses
Volutional acts experienced as controlled by others
Delusional Perception
Subjective thought disorder vs Auditory Hallucinations
Barrett
Iban concept of thinking arises from the
heart-liver region of the body
Personhood is defined not as a matter of
thought and mental privacy, but as an
aspect of verbal interaction
Correspondence between concepts of
thinking and talking in Iban cosmology
Contrast between auditory hallucinations
and thought disorder based on cultural
concepts
Barrett
Auditory hallucinations ever experienced
- 48 of 50 Iban patients
- 40 of 50 Australian patients
Subjective Thought Disorder ever
experienced
- 3 of 50 Iban patients
- 39 of 50 Australian patients
Barrett
• Translation of thought disorder questions
did not make sense to participants
• Disturbances in speech are interpreted as
disturbances in thought in Australians
• Disturbances in speech are interpreted as
disturbances in auditory reception by
Ibanese
Barrett
• Conclusion
– It is necessary to understand the meaning
systems of the culture in order to frame
diagnostic questions
– Cultural systems determine how symptoms
are experienced by patients
– Cultural systems affect the kinds of symptoms
that are reported by patients
Corin, Thara & Padmavati
Chennai/Madras, India, South Asia
• Study of the subjective experiences of
individuals with schizophrenia
• Use of narratives to study individuals and
families
• Three patient themes identified
– A quest for significance
– An appeal to religious referents
– The construction of a withdrawal space
Quest for Significance
Traditional Etiologies Used by Families
Malevolent humans
Malevolent spirits
Karma
Astrology
All were used to place disordered behavior
into a normal worldview
Corin, Thara & Padmavati
Withdrawal into Religious Ideology
Patients withdrew from family and other social
contact perhaps to reduce stress
Withdrawal was seen as creating a boundary
dividing the confused self from intrusion.
Withdrawal created “inner spaces” that the patient
occupied.
“Inner spaces” were labeled with marginal religious
or personal religious terminology
Withdrawal associated with pilgrimage, temples,
mosques
Withdrawal based on the Indian ideals of
renunciation and austerity
Corin, Thara & Padmavati
• Participants developed strategies for
dealing with suffering and fear
• Participants used cultural themes to
interpret their experiences
• South Asian culture is tolerant of
psychosis and deals with it within the
family context.
Good and Subandi
• Yogyakarta, Java, Indonesia
• Brief, acute, episodic psychosis (less than the 6month requirement for DSM-IV diagnosis)
• Non-affective, Acute, Remitting Psychosis
(NARP)
• 10 times higher incidence in developing
countries than in industrialized nations
• Twice as many women as men
• Duration usually 4-6 months
• Studied in terms of ideas pertaining to the self
rather than as psychophysiological state
Good and Subandi
The Javanese World View as Context
Self as a form of potency
Self developed through a variety of spiritual
practices and self restraint
The ability to maintain a refined, controlled self
is central to normal behavior
The powerful self can relate to and interact with
the unseen spirit world without being
harmed
Purity of body and spirit is essential
Purity is attained through ritual practices.
Good and Subandi
• Case Study: Yani
• Episodes of illness from college on
• Symptoms: “irritated, frustrated, disappointed”,
fearful, disoriented, withdrawn
• Leaving home and wandering aimlessly
• Illness framed as a desire/need to find pure
Islam
• Yani withdrew into her room and into religious
ritual to cope with her illness
Wilce
Bangladesh, South Asia
Mental illness is shaped by
Metacommunicative ability
Gender roles
Aesthetics of behavior and use of language
Concept of “pagalami”
Described as being like the behavior of
goats =
Out of control, oral, intrusive, embarrassing
Wilce
Causes
Can be divinely inspired ecstacy or
insanity
Can be “spiritually caused” (then ritually
treated) by a “wild spirit” or “jinn”
Can be caused by the patient (breaking
taboo, etc.)
Can be intrinsic to the personmathakharap = bad head
Wilce
Symptoms
Speaking in ways that violate the protocols of
polite conversation
Speaking in ways that are not gender
appropriate
Eating or any other behavior that is done
excessively
Family members try to shape and correct speech
acts so that they will be appropriate
Diaz, Fergusson & Strauss
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Bogota, Colombia
Spanish, Indian, African Cultural Mix
Spanish Language
Study of homeless, poor, schizophrenic
individuals through FUNGRATA
• 6 Ethnographic interviews
Diaz, Fergusson & Strauss
• Symptoms were seen as protecting the
participants from factors in everyday life
• Explanations of illness were central to
improvement and participation in the
program
• As explanations aligned with the ideals
and practical aspects of the program, it
was more likely that individuals would join
the program and show improvement.
Diaz, Fergusson & Strauss
• Work was a key factor in improvement
• Learning and the acquisition of skills were
important in improvement
• Medication was important, but second to
work
• Religious concepts and meanings were
used to explain symptoms by many
Diaz, Fergusson & Strauss
• The goal of FUNGRATA was:
“the construction of personal meaning within
an organized community setting”
Sadowsky
• Yoruba Ethnic Group, Nigeria
• Historical study of diagnosis in colonial
period
• Use of historical records from
asylums/hospitals between late 1800’s
and 1960.
• Opening two asylums to deal with
homeless mentally ill
• Focus on context and content
Sadowsky
Yoruba Traditional
• Madness in Yoruba culture– “were” and is
translated as “foolish or silly person”
• Causes include organic and physical
problems, bewitchment, actions by deities
• Breach of taboo causes spirit (orisa) to
impose madness
Sadowsky
• Records show diagnoses that include
political content
• Political content includes rage and
paranoia about colonial government and
its treatment of indigenous people
• Does this mean that some diagnoses were
politically based or that the content of
delusions were focused on problems of
oppression that permeated the society?