Diversity in Mental Healthcare - Schizophrenia - Essay Example

RUNNING HEAD: DIVERSITY IN MENTAL HEALTHCARE Diversity in Mental Healthcare: Schizophrenia of Abstract Today, among others, probably the most complex cerebral or mental disorder we observe is Schizophrenia. The behavioral aspects and illusions that a schizophrenic experiences are the issues that clearly distinguishes the disorder from other mental diseases. Moreover it is surprising that experts today have not been able to develop a single or sequence of approaches that are conclusive in the treatment of schizophrenics, this is largely due to the fact that as the disease can occur in just any kind of community, patients behaviors are highly dissimilar probably because the cultural and ethical backgrounds to which they refers causes them behave heterogeneously when they receive medical treatments or communicate to experts. This paper first emphasizes on the possible causes of the disorder in general then specifically refers to the cultural aspects that may lead to dissimilar behavior of the sufferers of the disease due to cultural diversity. Moreover it touches to the implementation of strategic approaches for schizophrenics with cultural diversity and the importance of the family support for the betterment of the patients of the schizophrenia. Diversity in Mental Healthcare: Schizophrenia Introduction and Background Schizophrenia is referred to as a disorder in cerebral system that involves various combinations and permutations of surroundings and atmosphere, feelings, actions and thoughts. As a result of these disorders the sufferer adopts a way of living that is significantly different in various aspects to those who are living in the society of which he himself is a part. At least where certain areas of one's life are concerned, the sufferer of the disorder also referred to as schizophrenic, frequently appears to puzzle real life and actual events of his life with fantasies. In addition it is widely observed that he also diverts his attention to useless hallucinations and false ideas and beliefs. For instance it may be possible that he may assume himself assume himself a victim of a harsh prosecution. Not only this, but he may also have certain perceptual experiences that he may think have occurred these events wouldn't have occurred actually. The perfect and most common example would be that a schizophrenic may hear sounds and voices as if people around him are talking even if nobody is there or no one is talking or there is complete silence. It is important to know that the word "Schizophrenia" etymologically refers to a notion of splitting or separation or division between various parts or thoughts of the consciousness, however the way in which it has been used by the psychiatrists and other experts of mental disorders does not refers to a situation of split behavior. (Boyle, 2002) In contrast to other several cerebral disorders of which we know quite well as clinical entities from historical evidence and occurrences, it was by the end of the 19th century that schizophrenia was considered and differentiated as significant disorder, primarily by Emil Kraepelin a German psychiatrist who referred to this disease as 'Dementia Praecox'. After convincing himself and as Emil Kraepelin had believed that a dementia condition is by no means the ineluctable result of the disorder, Eugen Bleuler a psychiatrist from Switzerland created the term 'schizophrenia'. (Williamson, 2006) Occurrence The occurrence of schizophrenia is not limited geographically, as in all other communities and societies it occurs in all industrialized nations. Moreover, all classes are influenced by the disorders, but it is the case in larger megalopolises and metropolitans that the disorder is more frequent by three to four times more in the lower socioeconomic classes in comparison to the upper and middle classes. One of the reasons of this can partly be the lower social and economic mobility that is common in this class which leads to the development of the disorder. Although schizophrenia occurs in men at an early age, it is common in women and men equally. It is usually observed that the beginning of the disorder often taken place at the end or late teenage years or in the initial years of adulthood but this doesn't implies that it can't occur in later years, moreover it has been observed, but is quite rare, that schizophrenia in children i.e. initiation before the age of fifteen has also occurred. (Morrison & Miller, 2009) Possible Explanations There are a number of diverse theories and researches that have tried to conclude the possible causes of the development of schizophrenia. A number of infamous psychologists and psychoanalysts including Karl Abraham and Sigmund Freud have provided a number of reasons for the development of the disorder. They suggested that it can be due to undesirable interpersonal childhood relationships with members of family and specifically the absence of motherly love and affection in the early stages of childhood. Although strong empirical research data have not been sufficient enough to corroborate these claims it is the case now that biological elucidations and analyses are being preferred. (Berno et al., 2009) The frequent installments of the schizophrenic occurrences have been corresponded to the heightened levels of dopamine, and with reduced metabolism of glucose in the basal ganglia and frontal lobes of the brain particularly in the left hemisphere of the brain. Moreover schizophrenia is also understood to be related to a disturbed dispersion of the neurotransmitter glutamine between the frontal cortex and the thalamus. In addition, it is observed in some patients, who suffered from chronic mental disorder that their brain ventricles have enlarged notably. However, the swelling of the brain ventricles is not present in most of the pre-diagnosed schizophrenics and is found usually in unrelated forms. Fortunately, these collective discrepancies are not being considered to be used for the diagnosis of the disease and surprisingly there is no particular technique or lab test for its identification. Currently, some of the analysts may find slow acting virus to be responsible, while on the other hand some may point out, in most schizophrenic patients, to delicate brain impairment due to birth injuries. (Moritz et al., 2009) Based on following findings it can strongly be said that a genetic factor is involved clearly. Schizophrenia is expected in approximately 12% of the children whose one of the parents is or was schizophrenic and about 50% of the children when both of the parents suffered from schizophrenia. In addition about 10% of the sisters or brothers of the schizophrenics were prone to its occurrence and approximately 50% in the individuals who have a schizophrenic identical twin. It is important to know that adoption studies have suggested that family concordance relating to the disease is mainly accounted for by chromosomes rather than by surroundings. However, since the concordance rate for the twins is not 100%, genes cannot be the only reason for the development of the disorder. It is common among the researchers that actually both environmental factors along with biological predilections combine in order to determine that if one is a schizophrenic. (APA, 2000) Culture Diversity in Schizophrenia Jablensky (2004) has expressed that it is broadly observed that the incidence of the cerebral disorder Schizophrenia is spread quite regularly over various cultures and populations. The World Health Organization (WTO), in 1992, in their report has stated that analogous occurrence rates and similar patterns of the disease were discovered in 10 different nations. However, in contradiction, Chen et al. (2007) and Bray et al. (2006) have expressed that have challenged the cross cultural occurrence of Schizophrenia, as they stated that some studies have provided varying rates of the disorder. Moreover, Hopper and Wanderling (2000) have expressed that there is sufficient evidence to support the view that Schizophrenia is quite prominent in the urbanized regions of the industrialized nations and it may also be possible that factors such as poor health care, poverty and stress may be the cause of the disorder. A number of dissimilar elucidations have been provided in order to get a better understanding of the predictions of Schizophrenia in the industrialized nations, as stated by Lefley, (1990). It has been suggested by Tasman and Fink (1992) that it may be the case that lesser differences in the social classes in the industrialized nations and individuals suffering from Schizophrenia may experience lesser societal denial and disgrace. Therefore it can be said that the cultural acceptance of the social deviations associated to the schizophrenics in the developing nations to enable them to carry out a more productive and less stressful life comparatively. Moreover Lieberman et al. (2006) express that as the family relations are stronger in the developing countries thus it may be possible that support for the schizophrenics may be higher, whereas on the other hand as stated by Lefley (1990) and Mueser and fox (2000) that the western communities tend to be more individualistic thus they turn out to pay less attention to the family relationships and corroboration. It is argued that considerable significance is being placed on self in the western societies, this behavior place immense disabling impact on the schizophrenics who themselves are uncertain of their self or their self is either fragmented or is fragile. (Lieberman et al., 2006) The prominence of spirituality and religious beliefs are usually unaccounted for the sufferers of the schizophrenics. As argued by Comas Diaz and Griffith (1987) that religious beliefs may form prediction, development and phenomenology of schizophrenia. He further details on his view stating that in the Puerto Rico culture the ideology of espiritismo entails the notion that the real world and the spiritual invisible world interact in order to get sacred excellence, which consequently lead to less dishonoring, more desirable front of individuals with illusions. However, it has also been observed that such religious intervention in the treatment may distort the treatment. Heightened levels if religiosities have been observed in schizophrenics which in turn confuse the discrimination of delusional concepts from ethnically approved cultural values. For instance it has been observed that significant delusional aspects were found in individuals from recent religious changes and individuals with psychosis. Moreover patients may be misdiagnosed due to uncertain and unclear cultural, ethical and religious backgrounds. This may primarily due to the fact that some religious groups show reluctance in sharing their psychiatric signs to experts and professionals, as impacts of cultural customs are particularly relevant for the schizophrenics as expressed by Dana (1993). Thus it can well be said that the information of ethical and cultural rules are is crucial to circumvent the misinterpretation of the religiously limited ideas, practices and experiences in establishing the diagnosis. Moreover the cultural discrepancies have been discovered in the employment of health care resources. For instance the Asian Americans turn out to use lesser treatments and African Americans have been reported to use higher percentage of emergency services. It has been recommended that corresponding user and giver in terms of traditions may develop the preservation of minorities in curing. On the other hand a current analysis of African Hispanic America, and White schizophrenics showed analogous cure results, however, with gradual betterment rates in the communal operation for African Americans (Bae et al., 2004). Thus is seems that whenever curing resources are employed regularly the consequences of various ethnic grouping comes near to that of the Whites. In addition to the background, sex is also a significant factor in literature relating to Schizophrenia. It has been observed that females usually have late beginning of the disease, observe shorter and lesser hospitalization, and sustain better communal ability as expressed by Kreyenbuhl et al. (2003). However it is notable that the most studies regarding schizophrenia were performed on men and lesser research is available on women as the emphasis in various studies varies 60% to 100% of the emphasis on men. Therefore, literature that emphasizes on schizophrenic women, particularly curing conclusion researches, should be performed to establish if pharmacological and psychosocial treatments are similarly successful for both males and females. A dominative data is available about how hormones impact psychosis and late development of schizophrenia. (Kreyenbuhl et al., 2003) Implementation Strategy for Schizophrenic Patients with Cultural Diversity It is crucial to understand the ethical and cultural backgrounds and aspects of schizophrenics as these might unclear information. Inappropriate results may be reached due to the discrepancies in the health beliefs between the minority client and the main culture provider, therefore it is important that the experts try their best in order the properly understand their clients conventional health related beliefs, because if they try to integrate their own beliefs into their therapy then the patient may show hesitance and thus may not participate in the medication. It is suggested that there may be numerous aspects that may result in over diagnosis of the disorder in the African Americans (Barnes, 2004) such as cultural discrepancies in the presentation of the psychiatric indications, investigative predisposition of clinicians and the absence of understanding between minority clients and experts. Moreover the African Americans may also not seek for cerebral medication immediately due to a number of reasons of which a prominent barrier is to misjudge the need for treatment. The beginning of the psychotic indications may lead to consultation to family members, folk or spiritual healers or associated religious group or some may turn to alcohol or drugs. It was found that African American females turn to their minister, mothers, family physicians and female friends and males refer to their mothers, ministers, then wife and then father as a prime source of facilitation (Goater et al., 1999). Therefore in case of African Americans spiritual and religious characteristics can be crucial. Santiago (1995) suggests that in case of Hispanic Americans, service delivery should be provided with sensitivity due to platicando, respeto and personalismo, which influence the individualized and informal attention and curative association. In case of the Asian Americans eleven guidelines have been suggested specifically these are provision of positive reframes, assessment of immigration history, act in non-confronting way, establishment of professional creditably, respect towards family relations, provision of role induction, be directive, facilitate 'saving face', be present and problem focused and accept somatic complaints and assessment of support systems (Kim et al., 2004). As suggested by Kendler (1999) that it is crucial to be aware of the basic examinations while consideration of the various approaches to the treatment of schizophrenics. In the view three observations are suggested. Firstly, schizophrenia is common in individuals who have distinctive limitations and strengths, thus the treatment should be shaped as to how the benefits of these strengths can be materialized in correspondence to what extent the patient is affected by the disease. Secondly, it has been suggested by numerous researches and studies that the causes of schizophrenia can be due to psychological, genetic and environmental factors, this leads the experts to employ the non-pharmacological approaches on confront non-biological issues while on the other hand adopting pharmacological strategies to deal with the biological predicaments. Lastly as it is quite clear that schizophrenia is a multifarious disorders, thus a schizophrenic also is a unique and complex individual, thus it may be inappropriate to limit a patient to a single medicinal approach in order to deal with such a multifaceted disorder. Family Intervention The way in which the families interpret schizophrenia is largely influence by culture. A good understanding of the patient cultural background can significantly enhance the expert-patient relationship. Family education and continues corroboration is helpful to capitalize on the family support for the patient, this can be particularly crucial when the subject is under direct regulation of his family. Moreover in case of men family support is decisive who largely prefer to stay at homes during their treatment and in whom the disorder onsets earlier in comparison to women, and if the family is an extended one then the disorder in any one of the family members concerns the entire family this is quite common to Asian and other collectivist societies. Thus cerebral experts should be careful that kinship configurations can largely influence decision making. Bae & Brekke ( 2002) suggested that like many others, in Asian communities family members do not prefer to hospitalize patient instead they prefer to treat them at home, moreover they like to escort their patients to his visits to the doctors or physicians, as to them participation in the treatment decisions is necessary. It has also been found that potential changes the acculturation levels, diagnostic criteria and geographical locations may enable to obtain different conclusions in the literature. In addition to the above they also observed that the patients from collectivist or congregational societies tend to emphasize on harmonious relationship, sociability and family integrity. The prominence of integrating ethical and cultural aspects into the interventional approaches is important as the interception strategies that are planned to engage relatives and family members in a supportive endeavor may be more beneficial for minority members as their family tendency tend to be more mutually dependent in temperament (Bae & Brekke, 2002). References 1. American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders. Washington DC: Author. 2. Bae, S. W. & Brekke, J. S. (2002). 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