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Culture and Psychopathology

The Anthropology of Mental Illness

Georgi Onchev

The book sets itself the ambitious task of exploring the relationship between human culture and the phenomenon of mental illness, that which has embarrassed, fascinated, and challenged educated minds throughout the centuries. Various manifestations of this phenomenon are examined in specific cultural contexts, presented with notable competence, and illustrated with memorable descriptions of clinical cases. (…) The book and its author have many merits—the capacity to present a highly specialized subject in an intelligible, absorbing, and simultaneously profound manner; respectable erudition and academic self-discipline; and the notable skill of handling different domains of knowledge, among others. The most remarkable quality, however, is the author’s concern both for the reader—who is carefully led into quite unknown and still frightening territory—as well as for his protagonists, the mentally ill. All told, I believe that this book will be of interest not just to students of psychiatry, psychology, and anthropology, but also to a broader circle of readers who are excited by the wretched and admirable destiny of being human.

Haralan Alexandrov

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8 Schizophrenia and Culture


There is only one difference between a madman and me.

The madman thinks he is sane. I know I am mad.

S. Dali

If schizophrenia did not exist, it probably could have been invented. It is undoubtedly the most interesting and enigmatic human pathology that continues to puzzle and fascinate with the richness and incomprehensibility of its clinical manifestations. The connection between this illness and culture is fundamental to the debate between universalists and relativists in transcultural psychiatry. The WHO’s worldwide comparative studies of schizophrenia convincingly show its universality as a mental disorder, with similar prevalence and manifestation in different populations.88, 98 Nevertheless, some essential differences can be outlined according to cultural contexts: in the disease’s epidemiology, manifestation, course, and outcome.

These differences are not easy to explain through the paradigm of universal genetic illnesses. Genetic contribution to schizophrenia may reach 50 %—with the highest degree of concordance in monozygotic twins, indicating that at least half of the reasons lie outside of the genotype, e.g., viruses or ecological, social, or other factors. Contemporary genetic studies on copy number variations (CNVs) and single nucleotide polymorphisms (SNPs) reveal the role of de novo mutations with approximately similar rates in each generation.171 This role in turn has a phenomenological projection. Around 80 % of all patients with schizophrenia are sporadic cases, i.e., with no relatives experiencing overt pathologies, in contrast to the affective disorders which have higher occurrences in family histories. More...

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