Guilt and Depression: A Cross-Cultural Comparative Study

Abstract

Although nearly a century has passed since Kraepelin’s investigations in Java [Cbl Nervenheilk Psychiatr 1904; 27:468–469], one crucial question regarding guilt in the course of depression has still not been decided: Is there a more or less stable connection independent of culture, or is guilt confined to certain civilisations? This study investigated this issue in 100 Pakistani and 100 Austrian out-patients diagnosed with ‘major depression’ according to DSM-IV by means of standardised instruments (Schedule for Affective Disorders and Schizophrenia-Life Time Version, Hamilton Rating Scale for Depression, 21-item version). The experiences of guilt were subdivided into ethical feelings (ethical anxiety and feelings of guilt) and delusions of guilt. It turned out that ethical feelings could be found in both cultures regardless of age and sex. They seem to be primarily related to the extent of depressive retardation. However, the distribution of the two subsets of ethical feelings was culture dependent. Delusions of guilt were confined to patients of the Austrian sample. So, our data qualify the exclusivity of the aforementioned two points of view and support the need for a psychopathologically differentiated approach.

Old Wine in New Bottles?

“…During the time from 1975 to 1990, established religious traditions had changed extensively and new religious movements were able to reach many in particular young people [35]. This is confirmed by our own data [21,36]. We found a link between the attraction of religion for young people and the return of irrealistic delusional themes.…”

“…To explain the decrease in earthly guilt in combination with the stability of supernatural guilt, one has to distin- guish between guilt of actions, omissions and ontological guilt [27]. Earthly guilt in schizophrenia is mostly linked with the patient's believe that he/she is threatened or poisoned because of doing something wrong (actions or omissions).…”

“…The situation concerning delusions of guilt is more complicated. This may be due to problems of definition such as the differentiation between feelings and delusions of guilt [27]. Those two studies covering the longest periods found a decrease in delusions of guilt [5,7].…”

A Comparative Study of the Experiences of a Group of Hong Kong Chinese and Australian Women Diagnosed With Postnatal Depression

“…The literature suggests that ideas of guilt seem to be more frequent in Europe and North America than in Eastern cultures. The difference has often been interpreted as a consequence of socialization in a Judeo‐Christian culture (Stompe et al., 2001). In this study, all 12 Australian participants gave their religion as Christian.…”

“…Culture could also have an important influence on ways of expressing depression because of differences in beliefs, socioeconomic backgrounds, and healthcare delivery systems. For example, the literature generally suggests that people from Eastern cultures have difficulty in expressing their emotions and that somatization is common (Stompe et al., 2001).…”