School of Medicine and Health Sciences Poster Presentations
Culture and Psychosis: A Case Study
Poster Number
285
Document Type
Poster
Publication Date
3-2016
Abstract
Background: Multiple descriptive studies utilizing disease vignettes called short explanatory model interviews (SEMI) were undertaken in a rural district of Tamil Nadu, India to explore regional disease models of psychosis. Among community health workers, 87% attributed SEMIs to non-medical explanations. A similar study found community members believed social and financial problems resulted from violence, self-destructive behavior, sadness and alcoholism while possessions, hallucinations, irrelevant talk and bizarre behavior resulted from spirits, witchcraft and magic. Overwhelmingly, they believed violence/aggression required intervention which could be administered at a hospital or religious center. A study among a cohort of schizophrenic patients found that 70% attributed their situation to spiritual or mystical factors; only 22% attributed it to a disease model.
Case Presentation: Our patient was a 60 year-old Hindi speaking man with a history of hypertension, diabetes mellitus and alcohol dependence presenting with command auditory hallucinations (CAH), visual hallucinations (VH) and suicidal ideation (SI). Clinical interviews were conducted through an in-person translator who also served as a cultural broker assisting interpretation of our patient’s beliefs. Our patient immigrated 22 years ago from rural India. He reported that his wife had affairs with family members after he came to the US. CAH were of his wife and in-laws instructing him to commit suicide, bequeathing them his property. VH were family members poisoning his food. He started drinking 1/4 L of alcohol daily at age 16. He reports AH before drinking; as the voices increased he coped with increased drinking. He was sober for 1.5 years, during which time hallucinations continued. He lost his job due to drinking. He did not interpret CAH/VH as depression (Hamilton-D score: 13) or as illness but felt this bad luck was due to black magic perpetrated by his family. He wants the hallucinations to stop and believes they impair daily functioning by necessitating drinking.
Discussion: It is important to highlight the emic perspective of diagnosis and assess psychosis against cultural standards. Black magic is a commonly held belief in India but it is general, not directed at individuals. Therefore, belief of personal black magic persecution, as held by our patient, is an abnormal thought process.
Conclusion: Given our patient’s disordered beliefs of personal black magic persecution and his CAH/VH, outside the context of alcoholism, which impaired functioning, he was diagnosed with paranoid schizophrenia. This case highlights the importance of culturally competent care and considering culturally appropriate disease models in diagnosis.
Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.
Open Access
1
Culture and Psychosis: A Case Study
Background: Multiple descriptive studies utilizing disease vignettes called short explanatory model interviews (SEMI) were undertaken in a rural district of Tamil Nadu, India to explore regional disease models of psychosis. Among community health workers, 87% attributed SEMIs to non-medical explanations. A similar study found community members believed social and financial problems resulted from violence, self-destructive behavior, sadness and alcoholism while possessions, hallucinations, irrelevant talk and bizarre behavior resulted from spirits, witchcraft and magic. Overwhelmingly, they believed violence/aggression required intervention which could be administered at a hospital or religious center. A study among a cohort of schizophrenic patients found that 70% attributed their situation to spiritual or mystical factors; only 22% attributed it to a disease model.
Case Presentation: Our patient was a 60 year-old Hindi speaking man with a history of hypertension, diabetes mellitus and alcohol dependence presenting with command auditory hallucinations (CAH), visual hallucinations (VH) and suicidal ideation (SI). Clinical interviews were conducted through an in-person translator who also served as a cultural broker assisting interpretation of our patient’s beliefs. Our patient immigrated 22 years ago from rural India. He reported that his wife had affairs with family members after he came to the US. CAH were of his wife and in-laws instructing him to commit suicide, bequeathing them his property. VH were family members poisoning his food. He started drinking 1/4 L of alcohol daily at age 16. He reports AH before drinking; as the voices increased he coped with increased drinking. He was sober for 1.5 years, during which time hallucinations continued. He lost his job due to drinking. He did not interpret CAH/VH as depression (Hamilton-D score: 13) or as illness but felt this bad luck was due to black magic perpetrated by his family. He wants the hallucinations to stop and believes they impair daily functioning by necessitating drinking.
Discussion: It is important to highlight the emic perspective of diagnosis and assess psychosis against cultural standards. Black magic is a commonly held belief in India but it is general, not directed at individuals. Therefore, belief of personal black magic persecution, as held by our patient, is an abnormal thought process.
Conclusion: Given our patient’s disordered beliefs of personal black magic persecution and his CAH/VH, outside the context of alcoholism, which impaired functioning, he was diagnosed with paranoid schizophrenia. This case highlights the importance of culturally competent care and considering culturally appropriate disease models in diagnosis.
Comments
Presented at: GW Research Days 2016