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Episode 3: The Teenage Brain - Culture and Schizophrenia

PET scans
Brain scan of Schizophrenia patient (right) and normal brain (left). The normal brain shows more activity in the frontal cortex.

Schizophrenia is a form of psychosis characterized by symptoms such as disordered thoughts, hallucinations, delusions, and social withdrawal. Although it is believed that the illness has been with mankind for much of its' history, the diagnostic label was not coined until the early 19th century. Medical texts from the 1800s described schizophrenia as an illness that typically begins in young adulthood and often becomes a chronic, debilitating condition. Studies indicate that schizophrenia is more common in urban settings than in rural communities. This may be a consequence of the stress associated with urban living, or a result of the fact that people migrate into urban areas to seek treatment.

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Studies indicate that schizophrenia is more common in urban settings than in rural communities.

Overall, researchers have found that the rates of schizophrenia across diverse cultural contexts are strikingly similar. The developmental pattern of the illness is also very consistent across cultures, with the onset usually occurring when the individual is making the transition into adulthood. The fact that schizophrenia occurs at about the same rate across so many different cultures has led some theorists to propose that it stems from the human tendency to use symbolic communication. In other words, it has been suggested that schizophrenia is a disorder that has evolved along with the human ability to use language. Although the cross-cultural similarities outweigh the differences, there is some evidence that cultural factors affect the course and the pattern of symptoms in schizophrenia.

A group of scientists at the World Health Organization studied the differences between schizophrenics in developed and developing countries in an attempt to unravel what role, if any, culture might play in the development of the disease. This study showed that some symptoms of the illness, as well as its prognosis, differed from country to country. The course of the disease was generally more severe in industrialized nations than in developing countries. One reason for this may be that in developing countries, there is often a belief that mental illness is caused by supernatural forces and is therefore no reflection on the afflicted person. The extended families found in traditional communities may also provide a particularly supportive environment for recovery and rehabilitation. In addition, the lack of specialized jobs and competitive expectations in non-industrialized societies may allow a person with schizophrenia to reintegrate more easily into his community after a psychotic episode.

Western societies, on the other hand, vary in the kind of support systems they offer for patients suffering from schizophrenia. Also, the competitive nature of technologically advanced societies may impede the recovery of schizophrenia patients whose thought processes can be disrupted by the stress associated with the fast pace of industrialized life.

Some cultural differences are also apparent in the kind of delusions that occur in schizophrenia patients. Often, the delusions tend to reflect the predominant themes and values of a person's culture. For example, in Ireland, where religious piety is highly valued, patients with schizophrenia often have delusions of sainthood. In industrially advanced countries like America, patients' delusions tend to focus on sinister uses of technology and surveillance. Patients may report that they are being spied on by their televisions or that they are being X-rayed when they walk down the street. In Japan, a country that prizes honor and social conformity, delusions often revolve around slander or the fear of being humiliated publicly. In Nigeria, where mental illness is believed to be caused by evil spirits, delusions may take the form of witches or ancestral ghosts.

Interestingly, many behaviors that would be seen as schizophrenic symptoms in the Western world are considered signs of spiritual exaltation in developing countries. A person who claimed that he was a god on earth would be considered delusional in Western society, but in India, he might be considered a spirit medium who is the human incarnation of a Hindu god. Similarly, in some African cultures, hallucinations are not necessarily seen as a sign of mental illness. Shamans, tribal priests who act as intermediaries between the natural and spiritual worlds, are deeply respected for their ability to describe their experiences in the supernatural realm. Indeed, many tribal societies regard the spirit world as immediate and accessible and believe that they can communicate with their deceased ancestors. These beliefs reflect cultural norms and are not considered delusions.

Schizophrenia patients in industrialized nations also differ from those in developing countries in terms of the course of their illnesses. In the West, schizophrenia is usually a chronic illness, with a gradual rather than sudden onset of symptoms. In developing countries, sudden psychotic reactions of a brief duration are more common. These reactions are characterized by paranoid delusions and hallucinations generally precipitated by an intense fear of persecution through witchcraft or sorcery. Unlike classic schizophrenia, which is characterized by a lack of emotion and a withdrawal from reality, acute psychotic reactions more often result in excitability, confusion and intense emotion.

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