Schizophrenia

Schizophrenia is the least prevalent men­tal illness addressed in this chapter. Only about 1.3% of the U.S. population suffers from schizophrenia (U.S. DHHS, 1999). Schizophrenia is classified as a psychotic disorder and is defined as having at least two “characteristic symptoms such as delu­sions, hallucinations, disorganized or incoher­ent speech, grossly disorganized or catatonic behavior, or negative symptoms” such as inability to speak or lack of initiative or moti­vation (APA, 2000, p.

Overall, mental health disorders affect nearly 30% of the U.S. population in a given year. The number of people who are affected by mental health multiplies when family members, friends, colleagues, and commu­nity members are taken into account. Mental health disorders manifest differently in indi­vidual people, and there is significant evidence of how and why mental illness occurs across cultures.

Box 9.1 It Happens in Real Life: Diagnosis of Schizophrenia

The 48-year-old accused killer, deemed unfit to stand trial, has been diagnosed with paranoid schizo­phrenia. He was diagnosed with this disorder long before-years before-the shootings. He was a young adult when he began to struggle with illness. In the months leading up to that dreadful day in August 2005, the man's family noticed marked changes in his behavior.

The Role of Race, Ethnicity, and Culture on Mental Health

Race, ethnicity, and culture are complex con­structs that are used in research and practice to better understand mental health disorders. Race is a social category that distinguishes people based on physical and social character­istics that are defined as racially meaningful (U.S. DHHS, 2001), while ethnicity is centered on grouping people based on a shared history or heritage (U.S. DHHS, 2001). Culture is

a learned system of meanings that fosters a particular sense of shared identity-hood and community-hood among its group members. It is a complex frame of reference that con­sists of a pattern of traditions, beliefs, val­ues, norms, symbols, and meanings that are shared to varying degrees by interacting mem­bers of an identity group. (Ting-Toomey & Takai, 2006, p. 691)

Trying to tease out these constructs is beyond the scope of this chapter. However, the federal government and the research community tend to use race and ethnicity to categorize groups within the United States, while culture is used to discuss the components of these groups. This section uses these distinctions to discuss similarities and differences in the prevalence and experience of mental health disorders.

The U.S. government identifies four eth­nic minority groups: African American, Asian American/Pacific Islander, Hispanic American, and Native American/American Indian/Alaskan Native/Native Hawaiian and one ethnic major­ity group, non-Hispanic Whites (specifically Hispanics are described as an ethnicity, while the other groups are described as races).

Within the United States, ethnic diversity also has implications for financial diversity. Many families from ethnic minority groups have significant financial disadvantages; they are three times more likely than non-Hispanic Whites to fall below the federally recog­nized threshold for poverty level (U.S. DHHS, 2001). Poor SES, including lack of income, occupational status, and educational level, all have direct, and strong, linkages to poor mental health outcomes (Kessler et al., 2005; U.S. DHHS, 2001). Families in the lowest SES ranks are nearly two and a half times more likely than those in the highest SES ranks to suffer from mental health disorders (Regier et al., 1993). While there are many cultural aspects that merit discussion and examination, this chapter limits discussion to the major U.S. designated ethnic groups. Ethnic group differ­ences are described for three of the four diag­noses described (schizophrenia is not included as there is limited evidence of ethnic difference in part because of the low prevalence of the diagnosis). Then, a summary section rein­forces a key message that there is not much difference in the prevalence of mental health disorders between ethnic groups, but there are some differences in presentation of mental health and mental health services utilization.