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1st March, 2019

The Effects of Culture on Schizophrenia

“Schizophrenia” is a serious mental disorder, which can attack any human being of any

age irrespective of his country, culture, ethnic group or religion. This severe mental disorder is

regulated by the breakdown of thinking and cognitive processes and by the forced overcoming of

sick emotions and their emotions. According to the research of experts this severe mental

disorder affects 0.7-1% of people of the world population independent of gender, age, ethnicity

and culture. This mental disorder has strong approximation to attack people in the start of their

adulthood depending on their experiences and genes.

The mental health disorder affects man and woman in the same proportion. There are not

special regulators to attack man or woman. Cultural differences, ethnicity, religion and

demographic regions do not seen to have any effect in who falls prey to this mental disorder.

According to health systems in America, around one percent of the population falls prey to this

horrible mental disorder. The mental disorder of schizophrenia is like a puzzle which is difficult

to solve for not knowing the origin and the exact cause of its occurrence. Every human being
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person from any ethnic group or cultural background possess different genes which are

transferred to off springs. According to medical researchers, genes transmission is an important

clue to solve the puzzle. If a person develops schizophrenia, his children are more likely to have

this mental disorder.

This disease with less known causes, high rate of occurrence around the globe and

weakening and depressing symptoms, becomes one of the dangerous, sever, bizarre mental

disorder. It’s unknown and silent nature makes at a subject of study for a large number of reasons

around the globe.

According to Journal of Health Sciences, DSM-IU classifies anyone having at least one

of two positive symptoms (delusions, hallucinations, disorganized speech, grossly disorganized

behavior) or negative symptoms (flat affect, anhedonia, abolition) for significant portion of six

months, as clinically diagnosed schizophrenia(Banerjee, 2012).

Keeping in mind the strict parameter and criteria of this disorder, this question arises that

how different cultures, demographic regions and ethnic groups react and respond to this severe

mental disorder? As already mentioned that this mental disorder is observed all over the globe

irrespective of color, ethnic groups and demographic areas thus, it is very much evident that this

disease is a ubiquitous mental disorder. It is significant to explore that does this mental disorder

is perceived in the similar way in all the countries or cultures? As these different cultures have

different beliefs, treatment systems, symptoms presentations, it is difficult to answer the

aforementioned question in positive manner because research shows that schizophrenia is widely

perceived in different ways in different religions, cultures, traditions and ethnic groups. The

paper opens the different ways in which this severe mental disorder is perceived and presented.
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Around the globe different cultures or ethnic groups portray its symptoms and indications

remarkably in entirely different manners on the basis of social, cultural, ethical, religious,

tradition or spiritual norms and beliefs. More so, when it comes to its diagnosis or treatment, the

psychiatrists or medical works’ racial or cultural affiliations and biases become hindrance and

the implication of the disease schizophrenia in particular culture or language affects the

treatment of patient if they are brought to medical centers otherwise they are treated traditionally

according to implication and understanding of schizophrenia . Another point which opens up this

research is the cultural effects on the treatment of this disease. Most of the times patients from

different cultures, ethnic groups or regions are prescribed medical or ways of treatment that

totally contradict with their cultural norms and this practices often cause harm to patients.

This paper will cover the after mentioned research, cultural and ethnic presentations of

symptoms, difference in diagnosis and treatment and role of physicians to work in the cultural

and ethnic norms.

Cultural differences have a vital role to play in the understanding and presentation of

symptoms, the diagnosis and the curing of the people suffering from schizophrenia. Most of the

times the difference in cultural beliefs, treatment, prevention and diagnosis is only considered to

be dependent of the symptomatic presentation. However, as already demonstrated in this paper

that schizophrenia is independent of all the cultures, races and ethnicity but these various

cultures, ethnic groups and religiously different countries have different belief systems,

presentation, and treatment methodologies depending on their beliefs and norms. More so, the

most important of all the factors, the culture, is the environment that builds value systems, moral

beliefs and judgment, biases and perception which may affect any person in the medical care

system or the patients and his family.

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This severe mental illness is found in all cultures and affects both the gender equally

irrespectively to their culture or ethnicity Regardless of its occurrences, whether in Europe,

America or Asia this illness remains brutal for all people and affects one percent of the total

population of the world. It is alarming to know that around the globe only half of the

schizophrenic individuals obtain proper treatment in spite of the adversity of this disorder.

Although, this disease is wide spread but has different faces, names, and interpretations

around the world. In order to know how different could or would present schizophrenia to my

knowledge, different cultures from developing and developed countries and cultures are taken

into consideration. It is the most expected form of cultural differences in respect to schizophrenia

that symptoms of schizophrenia vary drastically from culture to culture and country to country

according to the social beliefs and norms of these cultures. The symptoms of schizophrenia

might be same biologically or medically but they vary in presentation culturally. The most

common symptom of schizophrenia is hallucination which is represented in different cultures

differently. In some of the cultures and countries people face visual hallucination more and in

some cultures and countries people face auditory hallucinations. This could possibly happen due

to the contradictions of particular cultures and countries.

Different studies have shown that symptoms vary on ethnic and cultural basis. The study

conducted on ethnic groups and cultural groups in United States and other counties, there are

mainly two components of the symbolic variation: the developing countries and the developed

countries. According to study of “Cross-Ethnic Symptom Difference in Schizophrenia”, America

mainly focuses on two group comparisons; African-American and White Americans. The study

claims that results of symptoms in these two categories are inconsistent and contradictory. This

study displays that African-American Schizophrenic patients show more anger disorientation,
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asocial behavior and hallucinations, while white people showed more frequent symptoms of

irrelevant speech and un-systemized delusions (Brekke, 1997).

Different countries and cultures around the globe not only show symptomatic differences

but also the difference in the presentation of these differences. These symptomatic differences

might be same biologically or medically but they are presented and interpreted differently around

the globe and especially, this difference is observed between developing and developed

countries. According to World Health Organization (WHO) studies have consistently

demonstrated a better course and prognosis for patients in developing countries than for those in

the industrialized countries (Brekke, 1997). The aforementioned references provide evidence that

schizophrenia is a mental disorder with many differences in the interpretation of its symptoms.

It is believed that core values and norms of a society are a key tool to develop different

emotional and mood schizophrenic patients. This severe mental illness is not found in any

particular country, culture or ethnic group so being at variance with each other these groups have

different ways of diagnosis and social determinants of schizophrenia. The cultural difference

does not only show the symptomatic differences but also the differences of diagnosis and social

determinants. Whether it is a traditional diagnosis by an ethnic group or by the medical

psychiatrists, this disease is diagnosed in different manners, keeping in mind that causes of

schizophrenia can be same in all the cultures or ethnic groups.

The diagnosis process of the schizophrenia is directly influenced by the norms and beliefs

of cultures around the globe. In any culture or in any group, patients are patients and they need to

be treated as soon as possible but that is only possible when there is proper check-up and

diagnosis by the psychiatrists. This practice is only possible when people feel comfortable going
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to psychiatrists, but majority of the schizophrenic patients have strong inclination towards the

soul-healers and spiritual religious quacks.

The initial diagnosis process in most of the developing countries start from the faith

healers or so called religious quacks. People in the developing countries have strong intentions

and inclinations towards the spiritual processes because the patients are influenced by the social

norms and beliefs of the society and they find the treatment of their mental illness from the

spiritual faith healers. According to the American Journal of Biomedicine, people in Iraq, being

formally less educated, tend to go to the faith healers in Iraq. The study of this article concludes

that faith healer consultation is popular and accessible among patients with schizophrenia in Iraq

(Rahim, 2013).

More so, use of biomedical and medicine treatment in developing countries is not a

common practice. Taking African country Ghana in account, it is determined that schizophrenia

in developing countries of Africa is also first diagnosed and treated by faith healers. The World

Health Organization (WHO) examines that about 80% of people who need mental health care in

developing countries go to indigenous or faith healers for care (Kpobi, 2018).

Around the globe all people suffering from schizophrenia are looked down upon and

treated negatively which develops stigma in them. Comparatively, patients in the developed

countries seem to rely on the biomedicine whereas in developing countries and cultures people

with schizophrenia are more inclined to spiritual faith healers, which is the result of stone aged

cultural norms and beliefs.

After knowing about dissimilarities among different cultures in terms of symptom and

diagnosis differences, it is required to present how different cultures around the globe provide
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treatment of their schizophrenic patients. Treatment is also another important factor related to

schizophrenia which is changed with a change in the demographic region, culture, ethnic beliefs

and country. Different types of medications are provided to the patients of schizophrenia from

diverse backgrounds. Interestingly, the real medication and treatment of schizophrenic patients

(family and doctor) also change with change in the culture and ethnic identity. In different parts

of the world patients’ social behavior is determined by the set criteria of beliefs and norms. In

developing countries like India, people are mostly uneducated, harsh in nature due to low finance

or agitated due to sexual desires and their behavior of treatment is different as that of a patient of

calm and peaceful country. Research shows the schizophrenia patients in India are not likely to

take oral medicine even after caring, loving or threatening (Banerjee, 2012).

Treatment and social status of schizophrenic patients varies from culture to culture and

cultures in the developing countries are almost same with same traditional beliefs about this

adverse mental illness. Mental illnesses have always been considered an offense or a sin by the

society. When a member from any society experiences mental illness, he or she is looked down

upon by the surroundings. People, being ignorant of the biological and social causes and facts of

the disorder, call his or her disease as “madness”. Taking a general understanding into account,

people in developing countries and cultures consider any mental sickness as something to be

ashamed of. The patients suffer from the severity of illness as well as the adversity of the

people’s opinion about him.

When, unfortunately, someone develops schizophrenia in these developing cultures or

ethnic groups, he is referred to as “mad” person, ignoring his needs and treatments. People with

cultural, religious, and ethnic beliefs do not consider the need to take that patient to medical

specialist rather, the patient is ridiculed for developing strange and bizarre behavior. The living
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standards and conditions of schizophrenic patients do not merely rely on the adversity and

severity of disease but also on the level of their acceptability and social standing in the society.

People, on the basis of cultural and ethnic beliefs, do not accept their social status in the society

merely because of their mental illness, which, the patients have no command in getting it or

getting rid of it. The research highlights that some rural cultures of developing countries with

their extreme beliefs, do not allow people to go to psychiatrist just because the patients do not

want to get tagged of “mad” in the society. People who suffer schizophrenia are strictly advised

to go to the faith healers because according to the cultural norms, going to spiritual, religious and

faith healers quacks is a common and recommended practice.

Despite of the fact the medical science has progressed enough to possibly cure any

mental or physical disorder, the schizophrenic patients face extreme criticism and stigma which

does not let them go to the psychological treatments. According to the Journal of Clinical

Practice Epidemiology in Mental Health, those suffering from schizophrenia face a considerable

stigma that limits access to treatment and hinders their full integration into society (Buizza,

2007).

Mostly people face stigma in terms of negative attitudes and prejudices by the

community. People develop unintentional biases about the patients which might not be true, and

the negative words and rejection in the participation of any social gathering are commonly

experienced by the schizophrenic patients.

In the social context, stigma is attributed to strongly discourage, degrade and discrediting

the patients with mental illness and to deny their social standing in the society. In the cultures

like rural India and Pakistan, the schizophrenic patients are not the only one in the predicament,

but their families and close relatives also suffer from the stigma. The disease itself might to harm
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the close relatives of the patient but the stigma around them hurts their ego, respect and social

status only because they are relative of a schizophrenic (mad) person. In these cultures a little

research and awareness has been done in order to reduce the stigmatic attitudes. The results of

efforts of reducing stigma show that not only patients should be rescued from stigmatic attitudes

but also their close relatives.

The stigma is not only prevalent in developing countries, but it is also experienced by the

patients of modernized and developed cultures like United States. Stigmatic attitudes might

differ from culture to culture or country to country but stigma stays there when a person

experiences mental sickness. According to study conducted in Fredrick Country in the United

States of Maryland by Schizophrenia Bulletin, “In one survey of family members performed in

the late 1980s, a vast majority of respondents reported that mental illness stigma was present and

had a negative impact on their ill relatives. The most commonly cited negative effects were loss

of self-esteem, difficulty in making and keeping friends, and difficulty in finding a job

(Dickerson, 2002).”

It is very much evident from the aforementioned stigmatic attitudes of both the cultures,

the developed and underdeveloped, that patients suffering from mental illness have least or no

social standing even if they are not faulty of doing anything sinister so the social, cultural,

religious or ethnic beliefs need to be restructured and awareness about the rights of patients’

needs to be spread widely around the globe.

Having talked enough about the causes, variations in symptoms and diagnoses, it is very

significant to explore the treatment and prevention methods and in some particular cultures to get

a better view of how different cultures or ethnic groups consider schizophrenia as a mental

sickness.
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Taking into account Muslim Culture from Pakistan, it is believed that schizophrenia is

prevalent in Pakistani Muslim Culture with all of its symptoms, social causes and drastic and

dramatic features. The studies conducted in Pakistan show that this severe mental disorders is

equally found to attack male and female population of the country including rural and urban

population. One of the study of the local doctors from Pakistan shows that patients suffering

from schizophrenia develop extreme stigma as already mentioned in the above research. The

depression in Pakistani cultures can become so severe that 6% percent of the people suffering

from schizophrenia commit suicide due to the severity and intensity of this mental ailment.

(Akhtar, 2016).

The patients suffering from schizophrenia in Pakistan are mostly unaware of their mental

ailment due to lack of education, awareness and literacy in the rural areas. So whenever anybody

is found to have this mental disorder, people always attribute it the attack of some demon or

devil spirit attack. Muslims have their own religious, cultural and ethnic belief systems so they

have their own system of treatment and cure. Majority of the patients from rural and urban

population tend to go to the faith healers instead of considering the need to see a psychiatrist. It

is believed that in Pakistan, every next person claims to be spiritual or religious quack.

Whenever, unfortunately, any patient comes to these so called faith healers and religious quacks

they give the patient some holy water or any sacred ointment.

Existing in the culture where social and religious beliefs are considered to be the most

important part of people’s lives, the schizophrenic patients sometimes go to visit the holy shrines

of pious people hoping that they would get rid of the possession of evil spirits. The worst side of

the social beliefs and ethic beliefs is displayed with the fact that poor schizophrenic patients are

sometimes punished brutally by their so called religious quacks with the intention that they are
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inflicting pain to the evil spirit not the patient with the firm believe that the evil spirit will leave

the body of the patient and patient will recover in a few minutes.

In the rural culture of Pakistan, people portray some super pathetic logic about the female

schizophrenic patients by saying that marriage is the best remedy and treatment for

schizophrenia. Such practices are also prevalent in other countries of Asia such as India and Siri

Lanka. Most of these countries share the same method of treatments but their religious, cultural

and ethnic beliefs can vary from each other. Here, in these demographic regions almost all the

countries have the same treatment methods and bear same experience of stigmatic attitudes for

patients. The most common form of stigmas of schizophrenia in these countries are rejection,

humiliation, isolation which do not allow patients to take initiative to go for medical treatments.

These Asian countries have almost same conditions and causes of schizophrenia. Religions of

these countries might be different but social context, cultural beliefs stigmatic experiences fall

under the same umbrella. The prominent causes of schizophrenia in Pakistani Culture are

poverty, unemployment, political instability, violence, urbanization, sexual abuse and other

social evils besides genetic and biological vulnerability and other countries around Pakistan

share the same causes of schizophrenia.

At the government level, contribution to fight against mental illness is quite

unsatisfactory because it is rare to find any specialist to deal with schizophrenia at government

level but local bodies such as non-government organizations are playing vital role to provide

services regarding mental illness in the rural and urban areas.

On the other side, it is observed that in the most developed and modern countries ratio of

schizophrenia patients is similar to Asian cultures but treatment methods might differ. Taking

into account the Black Caribbean of United Kingdom, it is discovered that the possibility of
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attaining schizophrenia in black Caribbean living in the United Kingdom is more than that of in

the white British people. This aforementioned information gives rise to a notion that

schizophrenia is dependent upon some particular cultural causes. “The largest study to date has

demonstrated a nine fold higher risk of schizophrenia in UK-resident black Caribbean: findings

that are of concern to black Caribbean communities, to their GPs, and to health service managers

responsible for resource allocation” (Jones, 2008). The social factors such as unemployment,

poverty, and lower social class are very much similar to that of developing countries which

display that culture has an important part to play in the prevalence of schizophrenia.

In order to understand the high rates of schizophrenia in cultural and ethnic groups there

is need of exploration of protective factors and measures. The South Asians tend to face this

mental illness more as they have experienced massive migrations, severe problems with cultural

assimilation and demographic disadvantages, and yet they experience only marginally higher

rates of schizophrenia than those of the white British population depending on the

aforementioned experiences.

Having read enough about the symptoms, causes, diagnoses and treatment of

schizophrenia, it is significant to evaluate that how physicians or psychiatrists can bring the

optimal care to the patients regardless of their cultural or ethnic beliefs. When anybody from any

part of the world falls prey to any mental illness, his cultural or ethnic beliefs become hindrance

in the way of his treatment and medical workers can play vital by treating that patient by keeping

his cultural and ethnic beliefs. "As William Osler said‐or is said to have said‐`Ask not what

disease the person has, but rather what person the disease has” (Fadiman, 1997). This statement

opens up the research further, that how medical workers can play their radical role in order to

provide optimal care to the patients of schizophrenia with diversified beliefs.

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A patient-doctor bond is considered to possess the highest power of healing and treatment

especially when it comes to mental disorders. Patients who dare to reach the psychiatrists, need a

trusted and strong bond with their doctors in order to share what they could not share with

anybody. For this practice, it is mandatory for the psychiatrist to be neutral and unbiased of the

patient’s cultural beliefs. The doctor-patient bond becomes even stronger when the doctors

shares some personal beliefs so that he may win the trust of the patient. This practice is very

much compulsory in treating schizophrenic patients. Many patients may feel more connected to a

physician when they know something of the physician’s life, and it may sometimes be

appropriate to share information about family or personal beliefs (Ludwig, 2014).

Occasionally, a physician or psychiatrist might come across a schizophrenic patient with

contradictory cultural beliefs with the physiatrist. The cause of his mental illness might be

something which the psychiatrist thinks is immoral. In such situations, the doctors do not have to

treat patients according to their or the patient’s cultural beliefs but only as a doctor.

When it comes to the medical treatment of the schizophrenic or other disorders, patients’

cultural and ethnic beliefs compel them not to fully act upon the recommendations of the

psychiatrist. This practice is observed due to the stigmatic attitudes that a patient might have to

face by acting on the recommendations of the patient. Patients mostly filter the instructions of

their psychiatrists through their existing cultural or ethnic belief system. More so, patient

centeredness is another important factor with which the medical workers can bring up the

optimal care for the patients.

The primary aim of the cultural competence and patient centeredness movements has

been to balance quality, to improve equity and reduce disparities by specifically improving care

for people of color and other disadvantaged populations (Saha, 2008).

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The world is growing day by day and new cultures are evolving with the passage of time

which prove to be a challenge for the care providers, doctors, hospitals and the officials of

medical industry to deliver services which are compatible with all the cultures and ethnic groups.

The concept of cultural competence is introduced by some of the medical officials that aims to

provider health care services that meet the social, cultural, linguistic, religious and economic

needs and beliefs.

All the medical experts can improve the health outcomes and quality of care by providing

optimal treatment to the patients especially the mentally disordered patients and this healthy

practice can be useful to eradicate the racial, ethnic, cultural and health discrimination.
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Work Cited:

1- Akhtar, Shakila. “Schizophrenia in Pakistan.” ISPS-US, Western Mountain Web Design,

2016,https://www.isps-us.org/art_pakistan.php.

2- Banerjee, Anwesha. “Cross-Cultural Variance of Schizophrenia in Symptoms, Diagnosis

and Treatment.” Journal of Health Sciences, vol.6, No. 2, July, 2012, pp. 18-24.

Semanticscholar, https://www.semanticscholar.org/paper/Cross-Cultural-Variance-of-

Schizophrenia-in-%2C-and-

Banerjee/9c0c507790f013fbe663cf4e5ab33ce8597f4bd5?navId=extracted.

3- Banerjee, Anwesha. “Cross-Cultural Variance of Schizophrenia in Symptoms, Diagnosis

and Treatment.” Journal of Health Sciences, vol.6, No. 2, July, 2012, pp. 18-24.

Semanticscholar, https://www.semanticscholar.org/paper/Cross-Cultural-Variance-of-

Schizophrenia-in-%2C-and-

Banerjee/9c0c507790f013fbe663cf4e5ab33ce8597f4bd5?navId=extracted.

4- Brekke, John S. “Cross-Ethnic Symptom Differences in Schizophrenia: The Influence of

Culture and Minority Status.” Schizophrenia Bulletin, Vol. 23, No. 2, 1997, pp. 1-2.

Academic.oup, https://academic.oup.com/schizophreniabulletin/article-

abstract/23/2/305/1934056.

5- Brekke, John S. “Cross-Ethnic Symptom Differences in Schizophrenia: The Influence of

Culture and Minority Status.” Schizophrenia Bulletin, Vol. 23, No. 2, 1997, pp. 1-2.

Academic.oup, https://academic.oup.com/schizophreniabulletin/article-

abstract/23/2/305/1934056.
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6- Buizza Chiara, “The stigma of schizophrenia from patients' and relatives' view: A pilot

study in an Italian rehabilitation residential care unit.” Clinical Practice Epidemiology

Mental Health. Vol. 3, No.3, Oct, 2007. Bentham open,

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2173890/.

7- Faith B. Dickerson, “Experiences of Stigma Among Outpatients With

Schizophrenia.” Schizophrenia Bulletin,Vol. 28, No.1, January 2002, p. 143-155.

academic.oup, https://doi.org/10.1093/oxfordjournals.schbul.a006917.

8- Fadiman, Anne, The Spirit Catches You and You Fall down: a Hmong Child, Her

American Doctors, and the Collision of Two Cultures. New York: Farrar, Straus and

Giroux, 1998. PDF.

9- Jones, Rogger. “Schizophrenia in black Caribbeans living in the UK: an exploration of

underlying causes of the high incidence rate.” British Journal of General Practice, vol.

58 No.55, June 2008, pp.429–434. ncbi.nlm,

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2418996/.

10- Kpobi, Lily. “How indigenous and faith healers approach mental health in Ghana.” The

Conversation, The conversation Media Group Ltd, 2 September, 2018,

https://theconversation.com/how-indigenous-and-faith-healers-approach-mental-health-

in-ghana-102181.

11- Ludwig,MaryJo. “Physician-Patient Relationship.” Ethics in medicine, University of

Washington, 28 October, 2014, http://depts.washington.edu/bioethx/topics/physpt.html

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12- Rahim, Twana & Rashid, Roshe. “Schizophrenia and Faith Healing in Najaf/Iraq.”

American Journal of Biomedicine. Vol. 2, June, 2014, pp. 702-713. Researchgate,

https://www.researchgate.net/publication/301566491_Schizophrenia_and_Faith_Healing

_in_NajafIraq.

13- Saha, Somnath. “Patient Centeredness, Cultural Competence and Healthcare Quality.”

Journal of National Medicine Association.Vol.100, No. 11, Nov, 2008, pp.1275–1285.

ncbi.nlm , https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2824588/.