Schizophrenia in Palau: a Descriptive Study

Abstract

The authors systematically studies 35 Palauan schizophrenic patients. Although these Western Pacific people demonstrated many of the usual features of schizophrenia, the sample showed an unusual 4:1 male predominance, a proclivity toward violence and substantial affective symptomatology. Male patients extensively abused alcohol and cannabis. The authors postulate that toxic, social change and cultural factors interact in Palau to place men at increased risk for schizophrenia.

Schizophrenia in Palau

“…Several researchers have invoked "development" as a the principal causal factor for schizophrenia in Palau (Kauders, MacMurray, and Hammond 1982;Hammond, Kauders, and MacMurray 1983). "Development" is a complex concept to operationalize, and this makes it difficult to test or falsify this widely held perspective.…”

“…It is a novel methodology for anthropologists and was chosen after careful consideration of alternatives because of several methodological advantages. Previous research on the expression of schizophrenia in Palau has focused on the occurrence of symptom types in subject cohorts (Kauders, MacMurray, and Hammond 1982;Hammond, Kauders, and MacMurray 1983). The PANSS methodology is more nuanced in that it considers the severity of individual symptoms for each study participant.…”

“…Members of the cohort were well educated (mean 10.6 years) and very well traveled by any standards, with more than 50% (57% of males, 55% of females) having lived abroad for six months or more. Hammond, Kauders, and MacMurray (1983) found that a considerable number of Palauans diagnosed with schizophrenia had had their first break abroad and suggested that this might be related to a general pattern of increased mental illness among emigrant populations. While there may be stress as-sociated with moving overseas, it should be pointed out that young adult Palauans frequently go overseas for work or education.…”

“…The use of street drugs was associated with a less-favorable outcome in schizophrenia in the WHO ten-country study (Jablensky et al 1992, 79). Both Hammond, Kauders, and MacMurray (1983) and Hezel and Wylie (1992) have emphasized the role of substance abuse as a potential environmental causative factor in schizophrenia in Palau. Hammond, Kanders, and MacMurray (1983) noted in particular the association between substance use and violence, and Hezel and Wylie (1992, 349) interpreted the "strong differentiation along sex lines with respect to drug use" as a potential cause for the relatively higher rates of male mental illness.…”

“…Second, at the level of contextual behavioral response to illness, we analyze the use and abuse of psychoactive substances by people with schizophrenia in Palau. Previous researchers have suggested that the high prevalence of schizophrenia in Palau is an artifact of development manifested particularly in the arrival and widespread use of exotic drugs (Kauders, MacMurray, and Hammond 1982;Hammond, Kauders, and MacMurray 1983;Hezel and Wylie 1992). This hypothesis is widely accepted, permeating not only academic theory but also popular and medical opinion in Palau.…”