Universality and Cultural Variation in Schizophrenia
Schizophrenia is a mental disorder, associated with abnormalities of brain structure and function, disorganized behavior and speech, delusions, and hallucinations (Schizophrenia, n.d.). There are cases of this chronic and disabling mental disorder in all the world, regardless the cultures and races. The fact has led scientists to the conclusion that it is a universal illness. Therefore the Diagnostic and Statistical Manual for Mental Disorders (DSM), published by the American Psychiatric Association (APA) offers to reach a diagnosis of schizophrenia on the basis of evaluation of a given set of criteria (APA, 2000).
However, numerous research testify that schizophrenia varies across countries and cultures. As any other psychiatric disorder, it is influenced by socio-cultural factors (Wolfgang, 2001). This has given rise to a dispute between universalists, who claim that particular social factors only modify a universal human psychopathology, and, on the other side, adherers of the relativistic approach, who claim that cultural aspects generate culture-bound conditions (Simons, 1996, Kenny, 1983 as cited in Wolfgang, 2001). The paper investigates the two controversial views to see whether schizophrenia is more universal or a culture-bound disease. A great number of scientists, especially in the area of psychiatric epidemiology, support universalistic approach to psychopathology. Their basic premise is that psychiatric disorders and syndromes are universal and there is a universal syndrome pattern for all their core symptoms. The variation, accordingly to this view, is possible due to differences in symptomatic manifestation of the disorder and the distinction between pathological and normal behavior common for the given culture.
As it was mentioned earlier, there is a given set of criteria for reaching the diagnosis of schizophrenia. The most recent ones are presented in the DSM-IV. People clinically diagnosable with schizophrenia are those who display at least two positive symptoms and/or negative symptoms for one month, and general disturbance for at least six months. Positive symptoms, according to DSM-IV, are excesses or distortions of normal mental functions. These are delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior. Negative symptoms exemplify loss or reduction of normal functioning. They are flat affect, anhedonia (inability to experience pleasure), abolition (lack of drive), or alogia (poverty of speech) (APA, 2000). Furthermore, the DSM also identifies four subcategories of schizophrenia: the paranoid, catatonic, disorganized, undifferentiated, and residual types which are distinguished by the unique combination of particular symptoms (APA, 2000).It is interesting to note that DSM-IV has a section on Specific Culture, Age and Gender Features for each disorder which guides the clinician on variations of the disorder that may stem from the individual’s culture, sex or developmental stage.
In regard to this, Canino and Alegria suggest that, contrary to what is commonly believed, the universalist position does not oppose the idea that dysfunction may originate from exposure to negative environments (2008). Nevertheless, the Manual has not formally incorporated social or cultural factors as criteria for diagnosing disorders. Thus, universalists stress on the comprehensiveness of the psychopathology underlying internal disorder with due respect for possible variation …