Physiological malfunctions predispose patients to suffer from some mental disorders and to dysfunction in social relationships. Schizophrenia is the most frequently occurring mental illness and has a biological basis. In a large scale cross-cultural study (WHO, 1979) 77.5 percent of psychiatric patients were diagnosed as having schizophrenia. More recent research in the U.S. found that 1.1 percent of the population suffered from this debilitating illness (Regier, Narrow, Rae, Manderscheid, Locke, & Goodwin, 1993). Schizophrenia is recognized as an organically based mental illness found in all cultures and is the result of biochemical imbalances combined with cultural or family dynamics. In other words schizophrenia includes a biological predisposition associated with salient environmental stress (Jablensky, Sartorius, Ernberg, & Anker, 1992).
Schizophrenia is also the most frequently occurring mental disorder cross-culturally characterized by emotional flatness, a lack of insight into the conditions of life, and delusions and hallucinations (most frequently of an auditory nature) and behavioral disorganization. The distortion of reality and withdrawal from social interaction impacts the patientís ability to lead a normal functioning life. Typically, the schizophrenic patient also suffers from cognitive, perceptual and emotional disorganization (Carson, Butcher, & Coleman, 1988). As noted it is now commonly accepted that schizophrenia has an organic basis, although the behavioral manifestations may be culturally determined. Culture can have a direct impact on the rate of schizophrenia in society through the discouragement of families with a history of schizophrenia to have children. There is also evidence that culture may increase the rate of occurrence through the stress experienced by the complexity of information provided to the vulnerable, and by encouraging people to make decisions based on uncertain information (Murphy, 1976).
The impact of culture can be observed in the relatively better prognosis for patients from developing countries as compared to patients in developed and industrialized societies. The cultural values in developing countries reflect collectivistic worldviews that emphasize the mutual support found in interdependent families and cultural groups (Hopper & Wanderling, 2000). Dominant symptoms of the illness may also be influenced by culture. For example a comparison between Japanese and European American schizophrenics showed that the Japanese were more withdrawn and passive compared to American patients an influence thought to be produced by Japanese cultural values in a hierarchical high power difference society (Sue & Morishima, 1982).
Culture may also impact the diagnostic process. Leff (1977) found that U.S. clinicians gave more diagnoses of schizophrenia and less of depression compared to psychiatrists in England. Within the U.S. cultural impact can also be observed in different rates of schizophrenia diagnosis between ethnic minorities. African American and Hispanics patients were more frequently diagnosed with schizophrenia compared to European Americans (Blow, Zeber, McCarthy, Valenstein, Gillon, & Bingham, 2004). Cultural values cannot be separated from the affect of low socio-economic status among ethnic minorities as Blacks and Hispanics suffered disproportionately from poverty, drug addictions and other stress factors that contribute to schizophrenia. A similarly based result was found for African Caribbean patients in England as compared to the white population (King, Nazroo, Weich, McKenzie, Bhui, Karlsen, Stansfeld, Tyrer, Blanchard, Lloyd, McManus, Sproston, & Erens, 2005).
In evaluating schizophrenia and other mental disorders it is important to remember that beliefs that are considered delusional in one culture are not necessarily so in other comparative cultures. Access to mental hospitals also differ between countries and may explain part of the disparity in diagnostic rates. Gender related values may also affect diagnosis. For example schizophrenia is diagnosed more commonly in men in the Western world, but these results are reversed in China where for every three men, five women patients are diagnosed. Some have suggested that the stigma associated with the illness is higher for men, therefore leading to reluctance by psychiatrists in China to provide the diagnosis (Phillips, Yang, Li, & Li, 2004).