On Cultural Paranoia

In their 1968 book titled Black Rage, William H Grier and Price M Cobbs introduced the concept of Cultural Paranoia into Psychiatry. Described as an adaptive and healthy response to racial discrimination and oppression, cultural paranoia is marked by an almost obsessive fixation on cultural mistrust of the black American to the White man.

Among the Yoruba of Nigeria, there is a similar pervasive cultural paranoia however, in this case, the Yoruba does not suspect just someone from another race or culture but anyone apart from himself. This attitude is marked by sentiments such as "trust no man", "every man for himself", etc.

The worldview of the Yoruba is characterized by a constant struggle between forces of good and forces of evil and man is caught in the very centre of this struggle. It is believed that human beings can aid and abet the forces of evil and direct their maliciousness against a man thus it is believed that one must be careful and give the "enemy" as little a chance as possible to harm one.

The impact of this belief system is seen in the manifestation of psychiatric disorders. Cultural variation is most pronounced in reactive and neurotic disorders but the influence of culture is also significant in the major psychoses and can even be recognized in organic brain syndromes.

Studies conducted on the symptomatology and outcomes of schizophrenia among various cultures revealed that first, psychoses are not culture specific or culture bound but also and more importantly, the symptom profile, course and outcomes are influenced by socio-cultural factors. These studies (the very significant ones include the international collaborative research projects undertaken by the Mental Health Division of WHO, the International Pilot Study of Schizophrenia (IPSS) and the study of the Determinants of Outcome of Severe Mental Disorders (DOSMED)) reveal that the socio-cultural contexts of the patient determine to some extent the illness experience.

In the West, schizophrenics often manifest more depressive symptoms, primary delusions and other formal thought disorders however in developing non western countries, auditory hallucinations predominate (SARTORIUS et al. 1986; JABLENSKY et al 1992). A comparative DOSMED study conducted in India and Nigeria suggested that the content of psychoses is a function of the social and cultural problems specific to a culture.

Among a cross-cultural hospital population that was studied by Ndetei et al in 1984, it was found that there were cultural differences in persecutory, grandiose and religious, and sexual and fantastic delusions, accounted for mainly by the relatively higher frequencies in the African and West Indian cultural groups; this phenomena can be understood in terms of the cultural backgrounds of these groups. In this study, it was further argued that similarly defined persecutory delusions have a wide clinical significance that goes beyond schizophrenia in some cultural groups.

In a South African study where a sample of Xhosa people with Schizophrenia was studied, persecutory delusions were seen as the most commonly reported delusion and and delusional content drew from cultural explanations of illness and a bewitchment framework particularly in respect to delusions of persecution and reference (Campbell et al 2017).

The predominance of persecutory delusions and of auditory hallucinations also in non-schizophrenic disorders suggested to African investigators that these symptoms are not necessarily indicative of schizophrenia in persons of African cultural background (NDETEI & VADHER1984; NDETEI 1988).
That the influence of ethnicity and culture on psychopathology weighs more than geographic proximity, historical relations and racial similarity, became evident in studies which demonstrated significant differences in the symptoms of schizophrenia when comparing patients in Malta and Libya, Japan and China, Korea and China (MASLOWSKI 1986; FUJIMORI et al. 1987; KIM et al. 1993).

Ethnic and cultural differences are reflected in the schizophrenic symptom profiles even if the populations adhere to the same religion, as revealed in the findings of a comparative study of patients in Pakistan and Saudi Arabia (AHMED & NAEEM 1984).

The question that begs a precise and accurate answer is simply the role of cultural beliefs in psychopathology. Do cultural beliefs have a role in the pathogenesis of psychiatric conditions or are they merely pathoplastic(i.e. illness shaping)? The cause of mental illnesses is decidedly complex and in a good number of illnesses, the exact cause is unknown. There is however an interaction between biological, environmental and psychological factors in the causation of illness.

The contemporary model of illness causation is the Bio-Psycho-Social Model where a physical or biological risk factor exists and predisposes one to the illness, however psychological factors like cognitive biases, emotional influences, coping styles and defense mechanisms, personality types and temperamental leanings, etc and social influences including bullying, abuse, dysfunctional family relationships, lack of social cohesion and other overwhelming life events then contribute to the development of the disease.

The role of faulty interpersonal relationships characterized by enmity among family members especially in the context of a polygamous family setting where wives and consequently their children compete for love, power and acceptance, poverty, stigma and discrimination and other adverse life events that solidify feelings of isolation and persecution and the traditional African worldview of "them against me" and the "enemies of my destiny" mindset in the pathogenesis and or pathoplasticity of psychiatric condition is yet to be fully clarified and elucidated.

Research directed in this area will help to explain the influence of cultural belief systems in mental health but also assist in designing therapeutic models that incorporate a cultural framework that removes an undue emphasis on fear, mistrust and victim mentality. Instead socio-cultural values that encourage industry, resilience, family support and good health seeking behaviour will be emphasized.