Cultural Considerations in Schizophrenia
Varied Expression of Symptoms in Different Cultures
- Hallucinations and/or delusions may be articulated differently by people of different backgrounds.
- For some, hearing an ancestor's voice may be accepted and considered normal, while in western psychiatry, it's regarded as an auditory hallucination.
- Delusions are not only influenced by culture, but are also centered about it, for instance, in witchcraft, people and spirits, governmental surveillance, religions, etc.
Influence of Norms and Stigma on Reporting
- Individuals may conceal or minimize symptoms, especially in cultures that have strong stigma around mental health.
- Families may perceive these symptoms as spiritual or moral issues, rather than medically oriented.
Risk of Misdiagnosis
Because different cultures have different behavioral norms, clinicians might misdiagnose:
- ritualistic behaviors that are accepted/ expected in that culture
- expressive styles that are common and accepted in that culture
- active and intense participation in spiritual pursuits
as manifestations of psychosis.
This is the reason for the requirement of Cultural Formulation Interview by DSM-5-TR (APA, 2022).
Cultural Variation in Outcomes
In multiple research studies, the outcome of schizophrenia varies in different parts of the world:
- Some low- and middle-income countries have positive outlooks in the long-term, and this is attributed to strong family support and social stigma in the community.
- Western countries have higher rates of relapses in this area due to the prevalence of stress and lack of integration in the community.
Interpretation of Hallucinations
- In the U.S, patients with schizophrenia tend to hear very negative and threatening voices.
- However, patients in Ghana and India generally hear more familiar, comforting, and guiding voices.
Such overwhelming disparity reflects the difference in culture and the way the self and the mind are perceived.