Suchergebnisse

The recent development of transcultural psychiatry has questioned the assumption that schizophrenia is an illness which takes a chronic course, eventually terminating in clinical deterioration, as a result of an irreversible disease process. This paper attempts to elucidate cultural impact on chronicity of schizophrenia, through two case analyses of male Japanese- Americans. Value saturation in group-oriented culture and persisting diffusion in ethnic iden tity were identified to be two different modes of impact of culture on the chronicity of schizophrenia. It has been assumed that schizophrenia is an illness which takes a chronic course, even tually terminating in clinical deterioration. This chronicity of schizophrenia is assumed to result from irreversible disease process. However, recent studies in transcultural psychiatry have revealed different courses of schizophrenic illness in developing countries. Rin and Lin (1962) found few severely deteriorated patients among aborigines in Taiwan; their psychotic episodes are characteristically acute in onset and short in duration. In rural Ghana also, Field (1968) hardly found any deteriorated cases. However, these are not studies to follow-up the outcome of schizophrenics; the first well-designed investigation of this kind was by Murphy and Ramon (1971). They reported the results of a twelve-year follow-up survey of schizophrenics from Mauritius and compared them with the outcome of schizophrenics in London. This revealed that schizophrenics in Mauritius had a better outcome, which could not be accounted for in terms of better treatment, shorter hospitalisation, easier environmental conditions or more liberal standards of outcome. They suggested, therefore, that the question of chronicity in schizophrenia needed re-examination, with more attention being paid to the course of the disease in non-European peoples. However, there are difficulties in conducting cross-cultural studies in mental illness — diagnostic criteria for mental illness vary from country to country, while sampling of psychiatric patients may be biased, because the concept of mental illness and attitudes to it vary with cultures. Minimising these difficulties, IPSS (The International Pilot Study of Schizophrenia) in its world-wide survey, reported differences between schizophrenic patients in different cultural settings, with patients in developing countries having more favourable courses and outcome than their counterparts in developed countries (Sartorius. et al, 1978). Thus, cultural factors cannot be excluded in determining the course of schizophrenic illness. The present author (1980) has reported that male Japanese-American schizophrenics tended to take on more chronic courses than Caucasian ones in the Hawaii State Hospital. However, the mode of operation of cultural factors on the course of schizophrenic illness has never been clarified. The present study will attempt to elucidate it through case analyses. The following two cases of Japanese-Americans were treated by the author, while he was on the staff of a community mental health system in the State of Hawaii from 1976 to 1977. The focus will be on cultural factors, rather than on predisposition or psychological make-up.

A mental health survey was conducted using the Cornell Medical Index (CMI) on Vietnamese refugees who have resettled in Japan. 64.5% of the females and 37.2% of the males displayed emotional disturbance. The refugees with life-threatening and/or concentration camp experience had significantly higher CMI scores than those without it (t test, P<0.05). CMI scores of the group residing in Japan for 4-5 years are markedly lower than the group residing there for 2-3 years (F test, P<0.05).

Videotaped family interactions illustrating parent-child behaviour from American and Japanese clinical samples were assessed by psychiatrists and medical students in Hawaii and Tokyo, to study the effects of culture on the evaluation of behaviour. The results suggest that cultural factors significantly influence the assessment of inter personal behaviour, particularly highly overt and culturally patterned behaviour, e.g. parent-child roles and functions.

Remarkable improvements in economic conditions and a considerable upgrade in the quality of life have been observed in many parts of Asia during the past several decades. At the same time, many mental health challenges face the people of Asia. Various social mental health indexes are reviewed here, with available data from China, Japan, Korea, Singapore, Malaysia, and other Asian societies. The data are compared with data from the United States, Australia in the Pacific Rim, and some other Western countries to examine patterns of similarity or difference between East and West in the process of modernization. Common trends in mental health issues associated with rapid sociocultural change observed in different Asian societies are discussed, as well as the relative shortage of mental health personnel available in many Asian societies. It is emphasized that, in addition to expanding psychiatric services, there is an even more urgent need to promote mental health knowledge and concern through education in the general population. Mental health needs to be cultivated and maintained by social forces and cultural strengths. It is stressed that there is a challenge for Asian people to advance mental health beyond economic development in the 21st century.