Expressed emotion and schizophrenia: a review of studies across cultures

Abstract

Originally developed in Britain, the expressed emotion (EE) concept has now been used in a number of countries, both in Europe and elsewhere, and in a wide range of settings.The results are fairly consistent: most, but not all, corroborate the value of EE, in predicting relapse in schizophrenia. However, there has been considerable debate concerning the meaning and measurement of EE in cultures distant from that in which the concept originated.It has become clear that the different components of EE (emotional over involvement, hostility and criticism) have different significance for families from different cultural backgrounds and had differential power in predicting schizophrenic outcome.Two new studies are reported which investigated the relevance of the EE construct for British Asian families of patients with schizophrenia. A very high level of EE was found in the families of British Pakistani (Muslim) patients compared to that found in British Sikh andWhite families. However, for neither Asian sample did EE predict schizophrenic relapse.A second study examined EE levels in Asian families without a relative with schizophrenia and confirmed that higher levels of EE, and especially emotional over-involvement is the norm in Pakistani Muslim families.This research demonstrates how two cultures which may appear to be very similar to European researchers, that is, Pakistani Muslim and Indian Sikhs, are in fact very different in the way they respond to a mental illness in a relative.