Cross-cultural differences in recovery from schizophrenia: What to compare?

To the Editor

Recovery from schizophrenia involves re-establishing a full and meaningful life with participation in personally preferred aspects of community life, making of own decisions, and be in control of one’s life. The various definitions of recovery imply the need for environmental accommodations and community supports and creation of a person-environment fit, to promote recovery (Chinman et al., 2001).

The cultural milieu of populations varies in structure and dynamics over time and place. In addition, access to health and welfare services and related policies and practices that promote recovery vary widely between communities. Under these varied environmental influences, the experience and process of recovery could be different and need to be considered while conceptualising the main themes in recovery from schizophrenia (Jose et al., 2015).

Cross-cultural comparisons are made between different categories of populations. They are either racial categories like Afro-American and Caucasian or geographic categories of East and West or country-wise groups like Australian and Indian. Divisions based on national economic status such as developed and developing/Third World countries form another comparison group. There are some issues with these categorisations for exploring cultural influences on recovery.

A racially based category such as Afro-American denotes geographic/historic origin, not of a cultural or ethnic identity. The geographical designations to populations are inaccurate and falsely suggest common cultural identity. Life in the Fiji islands is not similar to that in Australia, though both are in the ‘West’. Worldwide migration over centuries and globalisation has created multiethnic-multicultural communities. The processes of acculturation and enculturation create a mix of various cultural identities within a population. Some could view the East–West dichotomy as a vestige of colonialist practices. The categories based on economic grounds does not address economic disparities within a country. The inequality and inequity in terms of economy, accessible health care and welfare services in both ‘developed’ and ‘developing’ countries impact health outcomes.

When sociocultural environment, economic and related health service factors are considered to affect the process of recovery, comparisons between groups of populations using categories mentioned above may not reflect the nuances of individual experiences. Relationship between culture and recovery needs to be understood in terms of the immediate living environment of the persons. It is recommended that cultural comparisons should be made using classifications of populations at the local cultural level and not use categories without cultural significance (Culture, Medicine and Psychiatry, 2018).