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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 - PowerPoint PPT Presentation
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Culture and the Individual
Schizophrenia
Schizophrenia
SymptomsDelusionsHallucinationsThought confusionFlattened or inappropriate affectWithdrawal into fantasy worldPurposeless excited motor behavior not explained by external stimuli
Not reported in ancient or medieval literatureMay be chronic and long termMay 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
BarrettFirst 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 & PadmavatiWithdrawal 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 6-
month 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 ContextSelf as a form of potencySelf developed through a variety of spiritual practices and self restraintThe ability to maintain a refined, controlled self
is central to normal behaviorThe powerful self can relate to and interact with
the unseen spirit world without being harmedPurity of body and spirit is essentialPurity 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
WilceBangladesh, South AsiaMental illness is shaped by
Metacommunicative abilityGender rolesAesthetics of behavior and use of language
Concept of “pagalami” Described as being like the behavior of goats =Out of control, oral, intrusive, embarrassing
Wilce
CausesCan be divinely inspired ecstacy or insanityCan 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 person- mathakharap = 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?