Cross cultural differences
Psychiatry is a culture-specific system of knowledge, power and institutions. Those with an interest in mental health wish to accumulate knowledge of how to make an accurate diagnosis and manage patients. However, the culture in which psychiatry is practised helps determine what constitutes a psychological condition and influences symptomatology.
There are differences between cultures in the prevalence of persecutory delusions, even in non-schizophrenic disorders, and of acute psychosis, much of which is culturally bound. For example, in Western Africa and Latin America, paranoid delusions and hallucinations are often triggered by an intense fear of magical persecution and witchcraft. In Indonesia and Malaysia, the stressor is fear of loss of fertility through ascendance of the penis into the abdomen.
These conditions are real within the cultures in which they occur – pain and physical symptoms are experienced – even though no physiological basis for them has yet been described.
In the West, patients with schizophrenia exhibit a greater level of depressive symptoms, primary delusions and thought insertions and removals than patients in developing countries. Conversely, patients in developing countries experience more visual and acoustic hallucinations than their Western peers.1,2
In a recent study a total of 1080 patients from Austria, Poland, Lithuania, Georgia, Pakistan, Nigeria and Ghana were diagnosed with schizophrenia using DSM-IV criteria.3 Not only were differences in the incidence of each type of hallucination reported (auditory hallucinations were most common; gustatory hallucinations the least), but pronounced differences in patterns between the countries were also observed.
The study’s authors concluded that the difference in the visual hallucination rate noted between Westerners and East Asians was likely due to cultural differences in perceptual and attentional processing. They noted that Westerners pay more attention to salient objects in an image than its background, unlike East Asians who pay more attention to the image’s background. They reasoned that this difference in visual processing could account for the difference in hallucination type between these groups.