Schizophrenia across different cultures

Kraepelin was the first to raise the topic of whether schizophrenia is a universal condition in 1960. Is it possible for it to happen to anyone or even different populations, cohorts, and cultures? According to the findings of the World Health Organization’s research conducted in 20 nations, Schizophrenia can affect anyone, regardless of their age, ethnicity, gender, or geographic location. [1] Even though the outcome of schizophrenia appears to be better in developing countries compared to developed countries, the reasons for this are not fully understood; however, it can be safely assumed that culturally determined processes, whether social or environmental in nature, are at least partially responsible. [2]

The pattern for most diseases is clear: the richer and more developed the country, the better the patient outcome. Schizophrenia appears to be different. This paradox first came to light 40 years ago. For further research, in the 1960s, the World Health Organization (WHO) launched the first of the following three landmark international studies: the International Pilot Study of Schizophrenia (IPSS); the Determinants of Outcomes of Severe Mental Disorders (DOSMeD); and the International Study of Schizophrenia (ISoS).

The IPSS included 1,202 patients from nine countries, three developing (Colombia, India, and Nigeria) and six developed (Denmark, Taiwan, the United Kingdom, the United States, the Soviet Union, and Czechoslovakia). The patients’ outcomes were rated from one (best) to seven (worst) based on three factors: time with psychotic symptoms, remission after each episode, and social impairment (worst). After five years, India had the most success, with 42% of cases reporting the “best” outcomes, followed by Nigeria with 33%. However, only 17% of cases in the US and less than 10% in other wealthy countries had the best outcomes.

In the early 1980s, DoSMeD began studying schizophrenia in 12 centers in 10 countries. From a single psychotic episode to a chronic illness, its 1379 patients fell into nine categories. The study found that 37% of underdeveloped countries had complete recovery compared to 15% of developed countries. Chronic illness rates were 11.1% in the developing world and 17.4% in the developed. Patients in developing countries had longer periods of normal social functioning despite taking fewer antipsychotics. The researchers discovered that a powerful element called ‘culture’ can influence gene-environment interactions that cause disease. The present study does not answer the question but simply states that it exists. To see if the prior studies’ better outcomes persisted, the ISoS trial added two more groups of IPSS and DOSMeD patients after 15 and 25 years. It found that half of the patients had positive outcomes.[3]

According to a 2009 assessment by psychiatrist Parmanand Kulhara of the Postgraduate Institute of Medical Education and Research in Chandigarh, India, 58 schizophrenia papers were examined in order to compare outcomes across industrialized and developing countries. The explanation doesn’t make any more sense. As Kulhara points out, “patients appear to be doing better in impoverished nations, even while resources such as health facilities and medical infrastructure are severely constrained,” including treatment facilities and treatment facilities. This could be attributed to the fact that developing countries have a different socio-cultural environment, with a larger reliance on family members for care and assistance, as well as stronger social support and social networking.[4]

If you ever found yourself on the verge of going insane, a supportive network like this would do everything possible to help you regain your composure. 

So does this imply that the greater the amount of support available, the more likely it is that someone suffering from schizophrenia will be able to improve? Perhaps. If you compare developing nations to developed nations, which are known for their individualistic cultures, developing countries are known for their collectivist cultures. To be clear, collectivist cultures place a higher value on the needs of a group or community than they do on the needs of an individual, whereas individual cultures are the polar opposite. As a result, a problem that affects one person affects everyone else.

Most developing countries have limited or no resources, as well as little or no awareness of mental health issues, but the good news is that they have each other. They are extremely supportive of one another, which is amusing because it is not necessarily because they want to, but rather because it is ingrained in cultural norms. And that is the most potent force they have; they either prosper or perish together. If you ever found yourself on the verge of going insane, a supportive network like this would do everything possible to help you regain your composure. Perhaps there is little time for one’s own thoughts because they are predominantly occupied by the group. A patient’s ability to maintain a satisfactory social support system is directly related to reduced hospitalization and re-admission to the hospital among those suffering from schizophrenia. Patients who have a larger network of people who care about them spend less time in the hospital and perform better on tests and assessments.

References

[1] Jablensky, A, and N Sartorius. “Is schizophrenia universal?.” Acta psychiatrica Scandinavica. Supplementum vol. 344 (1988): 65-70. doi:10.1111/j.1600-0447.1988.tb09003.x

[2] Kulhara, P, and S Chakrabarti. “Culture and schizophrenia and other psychotic disorders.” The Psychiatric clinics of North America vol. 24,3 (2001): 449-64. doi:10.1016/s0193-953x(05)70240-9

[3] Padma, T. V. “Developing Countries: The Outcomes Paradox.” Nature News, Nature Publishing Group, 2 Apr. 2014, http://www.nature.com/articles/508S14a.

[4] Parmanand Kulhara, Ruchita Shah, Sandeep Grover, Is the course and outcome of schizophrenia better in the ‘developing’ world?,Asian Journal of Psychiatry,Volume 2, Issue 2, 2009, Pages 55-62, ISSN 1876-2018, https://doi.org/10.1016/j.ajp.2009.04.003.
(https://www.sciencedirect.com/science/article/pii/S1876201809000306)

2 thoughts on “Schizophrenia across different cultures”

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