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Schizophrenia here is different than schizophrenia there — why?

Most diseases don't differ depending on where you're from. Schizophrenia, however, is heavily dependent on your culture.

Image source: Art by Lønfeldt on Unsplash
  • Since schizophrenia is a disease of the mind, the cultural context it occurs in can have a serious impact on how it manifests.
  • Cultures in which the family is more important will have delusions centered around their family, cultures in which religion is important often have religious delusions, and so on.
  • This growing understanding of the cultural sensitivity of schizophrenia highlights how much our identities are dependent on the cultures we grow up in.

Whether you're in North America, China, or the Antarctic, if you're diagnosed with diabetes, it's the same kind of diabetes. If you get lung cancer, it's not going to be a different kind of lung cancer just because you live in India. But schizophrenia can take wildly different forms depending on whether you're from Europe, Japan, Pakistan, or any other place on Earth.

Schizophrenia is a broad disease that presents with a constellation of symptoms, so it should come as no surprise that schizophrenia's exact characteristics differ around the world. For example, Westerners tend to experience more depressive symptoms in their disease. They're also more prone to thought insertions and thought removals, which are delusions centered around the idea that you don't have control of your own thoughts.

For thought insertion, the delusion is that somebody or something has placed thoughts in your mind, and thought removal is just the opposite; that some other has taken thoughts out of your mind.

Hearing voices

Photo by Kristina Flour on Unsplash

On the other hand, individuals in developing countries often experience more auditory and visual hallucinations. What's more, auditory hallucinations for non-Westerners tend to be somewhat "nicer," especially compared to Americans' auditory hallucinations. Stanford professor Tanya Luhrmann demonstrated this through research focused on 60 adults with schizophrenia from the U.S., Ghana, and India.

While many of the participants mentioned that they heard good and bad voices, Americans only reported having bad experiences with their auditory hallucinations. Ghanaians and Indians often heard voices that were described as playful or entertaining, but Americans had violent and threatening experiences. One American participant described their voices as "like torturing people, to take their eye out with a fork, or cut someone's head and drink their blood, really nasty stuff."

In a statement to Stanford News, Luhrmann said, "Psychiatric scientists tend not to look at cultural variation. Someone should, because it's important, and it can teach us something about psychiatric illness."

Luhrmann and colleagues speculated that the difference was due to distinct social values. Since Americans tend to value independence and individuality, hearing voices became an invasion, something violent by nature. But other cultures value collectivism more; this was backed up by the fact that the Ghanaian and Indian participants often heard relatives and friends speaking to them, while Americans generally heard strangers.

Delusional thoughts

Of course, hallucinations aren't the only symptom of schizophrenia. Delusions are a major component of the disease as well, and the nature of delusions differ across cultures, too. One study of 324 patients located in Japan, Austria, and Germany found that Austrian and German patients experienced more delusions centered around poisoning, around illness and death, and — most markedly — around religious topics of guilt and sin. The researchers chalked up the fact that religious delusions were more common amongst the Germans and Austrians to the greater prevalence of Christianity there. The Japanese tradition of Buddhism does not feature original sin so heavily as Western Christianity, and more Japanese individuals tend to be irreligious.

In contrast, Japanese patients were more likely to have delusions related to persecution by others, such as being slandered by coworkers. This, the researchers believed, was due to the larger presence of a shaming culture in Japan.

In keeping with these findings, another study found that Austrians had significantly more religious delusions than Pakistanis. Delusions of persecution were just as common among the two groups, but Pakistanis tended to believe their families were the source of the persecution more often, which is probably due to the stronger familial ties Pakistanis have in comparison with Austrians.

If anything, these studies highlight how strongly our culture contributes to our identities. An illness as profound as schizophrenia does not exist in a vacuum; it works on our minds, and our minds are the product of our larger cultural context.

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