Cross-Cultural Issues in Schizophrenia

Schizophrenia which is also known as the splitting of the mind is a clinical syndrome with severe psychopathology within several domains including cognition, emotion, and behavior. For other than a hundred years, divergent concepts have been discussed. Today, schizophrenia is classified descriptively according to criteria outlined by either the World Health Organization (1992) or the American Psychiatric Association (1994). The two systems have developed to be quite similar but there are some differences. ICD-10 emphasizes the character of the symptoms and DSM-IV gives weight to course and functional reparation. The present concepts of schizophrenia delineate a group of patients that is heterogeneous with respect to the extent of psychopathology, impairment of function and ability to manage a role in society. Some will suffer from one episode and be able to manage their lives after recovery, others will have several relapses with autonomous function in sandwiched between, but the majority will need treatment and support more or less continuously for the rest of their lives. The main clinical features consist of delusions, hallucinations, and thought instability, often called positive symptoms; and lack of drive, slowness, scarceness of speech, blunted emotional responses, and social withdrawal.

Clinicians and researchers have long believed that there is something fundamentally abnormal about the working of the intelligence in people with schizophrenia (Zakzanis, Poulin, Hansen, & Jolic, 2000). As a result of rapid technological development in recent years, several functional imaging techniques are now available for the in vivo consideration of human brain function (Garcia-Alloza & Bacskai, 2004).

Factors that contribute to Schizophrenia diseases include: Genetics, early environment, neurobiology, psychological and social processes among others. Some vacations and recommendation drugs appear to cause or worsen symptoms. Current research is focused on the role of neurobiology, although no single isolated organic cause has been found. The many possible combinations of symptoms have triggered disputes about whether the judgment represents a single disorder or a number of isolated syndromes. Schizophrenia does not only imply as a split mind and at the same time it is not the same as dissociative identity disorder which is also known as  multiple personality disorder or split personality which in this case, it is in a condition with which it’s habitually confused in public discernment

The Schizophrenia disorder is believed to be misery cognition, but it also habitually contributes to chronic harms with comportment and emotion. People with schizophrenia are likely to have additional conditions which even including major depression and anxiety disorders. Social problems such as long-term unemployment, poverty and homelessness, are common problems among people with Schizophrenia. The average life expectancy of people with the disorder is that betwixt 12 to 15 years less than those without, the significance of increased physical health problems have also contributed to a higher suicide rate among people suffering from Schizophrenia disease.

Most of the people diagnosed with schizophrenia may experience hallucinations which is believed to be a comportment of hearing voices, and this voices no one knows where they come from and they are accompanied by disorganized thinking and speech and as a result they end-up not having good flow of thinking leading to sentences which are loosely connected in meaning, to incoherence  it’s known as word salad in severe cases. Social extraction, sloppiness of dress and hygiene, and loss of motivation and judgment are also experienced among people having schizophrenia problems.

There is often an observable pattern of emotional difficulty, for example lack of responsiveness. Impairment in social cognition is associated with schizophrenia, as are symptoms of paranoia; social isolation commonly occurs. In one uncommon subtype, the person may be largely speechless, remain motionless in bizarre postures, or exhibit purposeless confrontations are also some of the signs of schizophrenia disorder.  Several cultures have their ways of which they look schizophrenia disorder and Asian and Hispanic has a way in which they view the point of this kind of disorder of the abdominal behavior

To start with, believes on culture and mental health can be looked with different perspectives of how they are carried on in different cultures. For instance, human beings are also referred as culture-bearing beings that communicate their inner consciousness to others. This includes pain, anxiety and pleasure. The cultural component decides the method of this communication. (DeVos and Boyer 2007)Anthropologist has long studied the differences of groups with their myths, beliefs, rituals and symbols. These differences play a significant role in defining behavioral maladaptions. The local community defines the norms and subsequently the abnormals.

The World Health Organization has been searching for universal psychiatric and physiological disturbances. Mental health reflects an individual’s realistic acceptance of self; clear perception of the world; open associations with others and the ability to handle stress and crises. This definition is able to be translated universally but specific events creating stress and subsequent behaviors are culturally defined. (Alloy, Acocella, Boatzin)

Two distinct views regarding abnormal behavior are, first, Kraeplin’s. He believed disorders such as schizophrenia, depression and sociopathy were present in all societies. On the other extreme are those researchers who believe “acting-out” behaviors are more prevalent in Americans as opposed to Asians. Asians are known for their restraint as demonstrated by self-control, lack of displaying feelings and calmness in problem-solving. Asians find it more acceptable to somatisize. Physical illness is not a shame and the emotional portion of the illness will dissipate when the physical ailment is treated. Studies have identified the Hispanic population as exhibiting more somatization and cognitive impairment rather than psychological disorders. Another variance is that cultures adopt deviant behaviors to survive a history of racism and discrimination.

In an American Psychological Association study in 1993, cultural differences were studied as demonstrated in behavior. The healthful, outspoken American woman may be viewed in some cultures as brazen. (Nevid,Rathus, Greene) Presently, compromise is that there are psychiatric and physiological symptoms that appear in situations of stress. These symptoms are universal to human nature. (DeVos and Boyer) Small close-knit communities do not present with psychiatric diseases since these simple, isolated groups are living in a relative unchanging condition.

The Asian abnormal behaviors are different from that of the expectations of the family-the need to excel for the prestige of the family. Honor is integral to every day living as evidenced by the ritualistic suicide when honor is lost (a loss of face). Closely linked to this is shame and bad behavior evokes shame. Children raised in these values want acceptance from parents and those in authority. The children conform to these standards. For some, the conforming causes anxiety. This anxiety results in shame, guilt or hostility. As it has been studied, these feelings result in psychophysiological symptoms. (DeVos and Boyer) Families are continuing to deal with wartime prejudice. This leads to poor self-image and again feelings of anxiety and depression. Women seeking help from depression are taught to be assertive with their husbands. Culturally, this is more adaptable in the Western world and may cause additional family conflict. Young adults have been taught the values of elder respect, loyalty and conformity and when they are westernized new views on dating and sex alter the self-image. This may also cause emotional and physiological disorders. Incorporated into the Asian values are understatements. This is exhibited in the little emotion displayed in grief and depression. Anger is expressed indirectly and the loss of temper indicated a serious personality fault. Modesty and discretion are highly regarded. For this reason, sex and family are private matters. In addition, speaking of accomplishments is viewed as boastful and reflects negatively on family and community.

Physical symptoms are accepted and are not viewed in a negative light. (De Vos and Boyer) The culture is not psychologically oriented. Discussions of feelings or psychological motives for behavior are not common in families. Disturbed behavior is viewed as a lack of will, physical illness or supernatural causes. The values of the family and community are central. Conflict occurs when children choose other values like long hair Non-academic endeavors, including extra-curricular activities are viewed as frivolous and are discouraged, another avenue for repressed feelings. There are strong cultural prohibitions against admitting personal problems. Shame is correlated with these problems. A stigma against the individual and the family occurs when these “weaknesses” are discussed. For this reason, researchers have long reported a low disturbance rate and feel there is no need to provide support in adjusting. (Pederson, 2004)


The values exhibited are the importance of the family; the extended family, the perception of the supernatural (Le, God) as the presenter of rewards and punishment and the importance of here and now in the individual’s life. Concrete communication is more prevalent than abstract issues. With these values is incorporated a devaluing of self-assertion with authority figures. Eye contact is discouraged, and silence is considered respectful to the one in charge. (Pedersen) Social scientists have indicated that slightly more than fifty per-cent complete high school. Since education is viewed as a stepping stone to economic stability and symbols of status, many of the difficulties are viewed as socio-cultural indicating family dynamics and gender roles are affected. (Kendall, Hammen) Psychiatric problems evidenced are depression, stress-related and somatic complaints. Among causes of deviation may be the value of conformity. Non-conformity indicates abnormality. (Pedersen) Many individuals view themselves as second-class citizens based on varying degrees of discrimination and oppression. Conflict may result from the past and present interrelating in a complex manner. To whom is the individual referring when he/she states “my people.” The Hispanic family unit is valued above the individual. For this reason, family matters and personal problems are private. It is unacceptable to discuss these matters with a stranger. (Pedersen) Genetic make-up that determines a propensity to certain psychiatric disorders is operational within the Hispanic population. These include anxiety, depression and alcoholism. (Sue, Sue, Sue1994)

Comparison among Asian and Hispac

As for the comparison of both pities, the disease mostly affects people with tender age of that between 12-15 years. These people suffering from Schizophrenia disease has similar symptoms in both pities like depression and anxiety disorders. Social problems which are believed to be long-term unemployment, poverty and homelessness, are the most common problems among people with Schizophrenia in both cases and they refer to human being as cultural beings as cultural-bearing beings. Experience hallucinations and lack of good flow of information is witnessed in both cases and therefore resulting to having many things of comparison of both cases.


On the side of contrast, the Asians are believed to control themselves than opposed to the Hispanic people. It is also believed that Asian people are not ashamed of their physical illness and they accept themselves the way they are and like the Hispania people who are ashamed of themselves and don’t accept the fact that they have mental disorders. The field study conducted showed that Asians are good and despite the believe that one can get the Schizophrenia disease from certain region, they can live long for they do accept the way they are hence try to live life not much stressing.


A cross-cultural model of counseling includes support during assimilation and acceptance of ethnic identity. During assimilation, the individual/group is being “Americanized.” The incorporation of the new values and new approaches are being integrated. Yet, the individual beliefs, customs and attitudes are part of the culture and indicate pride and a sense of self The problems seen are: alcoholism, drug abuse, child and adolescent adjustment disorders and identity and sexual conflicts.


Therapy sessions should be short. Their belief is they are “imposing” on the therapists.

They prefer the therapist be directive, goal-oriented and speak concretely – to the point.

Studies have indicated that few professionals are sought for help. Again, culture states that Elders are better suited for these matters. Individuals speak more freely with family.

Among the “cures” imposed by the Elders are increased effort and hard work to develop character. The verbally-oriented models may be inappropriate. Culture dictates that “talking-out” will not solve conflicts. The Japanese Morital Therapy concentrates on behavior rather than feelings and moods. The therapist and client are concerned with here and now. (Pedersen)


The therapist needs to be directive due to the deference to authority. Individuals express feelings openly with family and friends, but are usually silent in therapy sessions. Many folk-healing practitioners are still sought for physical problems and deviance. Again, the deviance is based on lack of conformity. Researchers have long determined that there is a lower incidence of mental disorders with the Hispanic community due to inadequate information. Families continue to be the emotional support providers. (Pedersen)


Schizophrenia is a severe and persistent mental illness that crosses all racial, ethnic, cultural, and demographic lines. The pressure of rank status, ethnic and cultural identity in relation to the presentation and the reporting of schizophrenia must be considered. Communication, coping styles, support system, and motivation to seek treatment are also affected. The factors discussed influence beliefs, attitudes, and behaviors regarding the identification of illness and health and in the process of treatment and recovery. The lack of educational and financial resources may create a barrier, in terms of utilization of services and compliance with treatment. Understanding how psychosocial factors within the cultural dynamics of this population would promote more culturally relevant care.