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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 • • • • 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?