Cultural factors in the genesis of schizophrenia

Abstract

ANY review of empirical data touching possible sociocultural influences on the genesis of schizophrenia must face serious difficulties, since such influences are overlapping continua, not simple dichotomies of presence or absence, and will almost certainly have interacted elaborately with each other before producing the final result. It is not to be thought, for instance, that the experience of a migrant is the same regardless of the social class he moves in, or that patterns of intrafamilial behavior are unaffected by the cultural expectations of the surrounding society, Accordingly, there are a host of concomitant variables which theoretically need to be allowed for when we seek to assess the relevance of any one, and since there is no study which has been able to handle them all the reviewer of such literature has continually to draw inferences from inadequate evidence. It is in some ways much easier to write a theoretical paper in this field, selecting hypotheses and suggesting means of testing them, than to write a descriptive one, when so much of what one would like to describe has never been filled in. These problems apply to any sociocultural approach to schizophrenia and to most other approaches as well, but one is probably more aware of them when considering specifically cultural influences, since culture interpenetrates all other aspects of social life. Culture, in the sense used in transcultural psychiatry, consists of the values, beliefs and patterns of behavior which a society teaches to its members, with a view to equipping them better for the task of life. In traditional societies we are accustomed to think of these beliefs and practices as maintaining an existence of their own with very little reasoned relationship to actual living conditions, but they did not start out that way, and beyond a certain point they do not persist in that way either, if they become inappropriate to actual conditions and if the society is making any attempt to adjust. The obvious analogy, though one which must not be pushed too far, is with habits of eating, walking, writing, etc., which are learnt by children and maintained throughout life with no rational reconsideration until some change, physiological or environmental, forces the person to examine whether the development of different habits might be more satisfactory. To discuss a particular culture without reference to the conditions to which it was a response can thus be as senseless as to discuss the sailor’s rolling walk without considering conditions at sea, especially if these conditions are no longer present. Accordingly, in evaluating a culture medically or in seeking the cultural determinants of disease, the conditions under which the culture developed are usually relevant, whether these conditions persist or whether they have changed, and although we may occasionally meet an association which persists despite the