No abstract

RECENT REPORT BY THE US Committee for Refugees estimates there are 14.9 million refugees and 22 million internally displaced persons in the world. 1 Most have experienced significant trauma, including torture, 2-4 as evidenced by prevalence studies in clinics and nonrepresentative community samples. [5][6][7][8][9][10][11][12] Health problems of refugees have also been documented. Clinical research demonstrates a high prevalence of posttraumatic stress and depression symptoms, 6,10,[13][14][15] and community studies using self-rated scales [2][3][4]8,10,16 and structured diagnostic interviews 9,17-19 have found wide variation in the prevalence of the symptoms of posttraumatic stress (4%-86%) and depression (5%-31%). Refugees experience multiple symptoms, 4,5,[20][21][22][23][24][25][26] perhaps due to the many types of insults experienced, 4,6,20,23,24,27,28 yet the significance of these symptoms is not clear since many are not characteristic of posttraumatic stress disorder (PTSD), depression, or other defined disorders. [29][30][31][32][33][34][35] A few community studies Author Affiliations are listed at the end of this article.

A number of studies have explored hallucinations as complex experiences involving interactions between psychological, biological, and environmental factors and mechanisms. Nevertheless, relatively little attention has focused on the role of culture in shaping hallucinations. This article reviews the published research, drawing on the expertise of both anthropologists and psychologists. We argue that the extant body of work suggests that culture does indeed have a significant impact on the experience, understanding, and labeling of hallucinations and that there may be important theoretical and clinical consequences of that observation. We find that culture can affect what is identified as a hallucination, that there are different patterns of hallucination among the clinical and nonclinical populations, that hallucinations are often culturally meaningful, that hallucinations occur at different rates in different settings; that culture affects the meaning and characteristics of hallucinations associated with psychosis, and that the cultural variations of psychotic hallucinations may have implications for the clinical outcome of those who struggle with psychosis. We conclude that a clinician should never assume that the mere report of what seems to be a hallucination is necessarily a symptom of pathology and that the patient’s cultural background needs to be taken into account when assessing and treating hallucinations.

The authors examined the role of family factors and the course of schizophrenia by carrying out additional assessments and analyses in 2 previously published studies of Mexican American and Anglo American patients and families. The authors found partial support for an attributional model of relapse for families who are low in emotional overinvolvement. Attributions of control, criticism, and warmth together marginally predicted relapse. The data also indicated that for Mexican Americans, family warmth is a significant protective factor, whereas for Anglo Americans, family criticism is a significant risk factor. These findings suggest that the sociocultural context shapes the pathways by which family processes are related to the course of illness. Moreover, the warmth findings suggest that families may contribute to preventing relapse.

No abstract