Gene, culture and schizophrenia
I have been living with schizophrenia for a decade. Schizophrenia is generally perceived as a debilitating illness that can create havoc in the life of the people who have them. In many cases, schizophrenic patients might have to spend most of their life in mental hospital, unable to do anything useful in life thus creating financial burden for the family. Fortunately, my experience of schizophrenia was rather different. Although, I have struggled dealing with this illness, it has not affected me in such a way that I have to live in a mental hospital. For me, being open about my illness helped a great deal in coping and managing it. However, opening up about one's condition might not be the only factor that helps ease, and recover, the patient. Interaction between culture and patient's genetic disposition plays equally important role, if not more.
Researches have shown that among all the risk factors for schizophrenia, which could include such factor as stressful pre-natal environment, immigration, cannabis usage, and so on, genetics is the most predominate one.
It was one of my psychiatric doctors who first brought to my attention the relationship between genes and schizophrenia. She gave me an example, that in a segregated population like Amish population in North America the chances that people with schizophrenia live a productive life is higher than in mixed population like the one in New York City. It is actually not the support that Amish schizophrenics may receive from family members that is key to their being able to lead a productive life (In fact, patients in New York City may also receive support from the family members); instead, it has to do with genes-environment interaction.
Predominate hypothesis states that the cause of schizophrenia is chemical imbalance in the brain. The chemicals in the brains are mostly neuro transmitters that transmit signals between neurons- from a pre-synaptic nerve to post synaptic nerve through receptors in the membranes of nerve cells. These neurochemicals are called neurotransmitters and those transmitters are used for signalling information from one nerve cell to another.
It has been shown by different studies that symptoms of schizophrenia vary across cultures. People of some countries may experience mainly auditory hallucinations while people from other countries experience more visual. One study even concluded that the differences in the amount of hallucinations is mainly due to how people from different culture visualizes the environment. People from Western culture are found to have more concentrated and concrete vision, and people from Asian culture having more abstract and conceptual vision. It has also been shown that schizophrenic patients from collectivist culture like India have been shown to be worse in ‘Facial emotional induction task’ where a particular facial expression is shown to the subject to induce facial emotions.
One hypothesis explaining gene-culture dynamics is ‘Norm Sensitivity hypotheses’. It says that the experience of a child growing up in a society creates norms, but those experiences vary in different individuals. The learning process in a child is created by reinforcing their experiences mainly through rewards. After around age 8 or 9, a child has already acquired ‘norms’ in a culture by sequentially selecting what is best for him and what is not. These ‘norms’ are later displayed when the child becomes adult by seeing how he interacts with different individuals. This all actually occurs in the level of brain.
Let us take one brain chemical in particular. The chemical goes by the name of ‘wonder-drug’ and is also involved in drug addiction. The chemical is Dopamine. It is mainly produced in the brain when a person is seeking reward. Schizophrenia is thought to occur when there is high level of dopamine in the brain. The anti-psychotic drugs used for treatment of schizophrenia are primarily dopamine antagonists. The genes for production of dopamine in the brain have recently been found out in addition to the genes causing schizophrenia.
Dopamine pathways in the brain have what is known as receptors. These receptors are channels through which dopamine passes from one nerve cell to another. These receptors have their own genes and their variants (known by the name of allele). One receptor in dopamine pathway is D4 receptor gene (DRD4). The genes of this receptor have different repeats (polymorphism) mainly with 2, 4 and 7 repeats (2R, 4R and 7R). Those with 7R alleles show less response to dopamine than those with 4R repeats. 2R repeats show medium response. Interesting about these alleles concerns the findings of differences among people carrying more 7R/2R alleles than 4R alleles. Studies have shown that although Asian people in general tended to be more interdependent than Europeans (who were more independent), the differences becomes null when tested with people of negligible amount of 7R/2R alleles.
Now the question arises: why population like Amish in North America have more success rate of schizophrenics living a productive life. The values inculcated by culture and reinforced by genes lead patients from particular cultures seek help when needed. Perhaps, coming from a collectivist and interdependent Nepalese culture, reinforced by my own individual values of love and friendship, were crucial factors that made me more successful in dealing with this illness.
(Dulal is currently pursuing PhD on animal welfare at University of Prince Edward Island, Canada. He blogs at www.ketandulal.com)
Fidel Castro’s legacy
Castro proved that socialism itself is not an inept and bankrupt idea, and kept on knocking at the doors of the capitalist countries to ruminate on their missteps during their colonial rule and to redress them by extending true helping hands – not those contaminated by greed, profit motives, and undue interferences – to the needy countries.
The problem of not cutting trees
A forest is a renewable crop, and just like agriculture, one could harvest old trees and then nurture new seedlings to come in the forest floor and grow into a mature forest again (of course subject to environmental limits which can be established through some methods of assessments and planning). But why doesn’t this simple wisdom prevail in Nepal’s forest governance and management circles?
Dr Hemant R Ojha
ECHO supporting for 'Open Defecation Free Nepal'
Realising the current situation and aiming to combat the problems of community people, ECHO has come forward as one of the key players to support the people in this VDC along with others so that they regain their ‘honor’ and the government of Nepal succeed in its mega plan ‘open defecation free Nepal’.
Hem Raja - Hotel de l' Annapurna
Somebody nudges me. I wake up and look up with bleary eyes at Mr. Shahdev SSJB Rana holding my uniform blazer in his right hand. Had my skin been white, I would have turned cherry red with a mixture of fear and shame at being caught so red-handed. And that too by the person who was second in position in the hotel food chain, only below Princess Helen Shah herself. Before I could blurt anything out at my Managing Director, he whispers, “Lamichhane, next time I will not give this blazer back for you to wear.”
Menstrual taboo outdated
I have seen my sisters and friends isolated and treated in discriminatory manner during their first menstruation cycle. They were not allowed to look at the sun, to touch water source, flower, fruits, any male family member, nor even hear their voice. The activist may claim the situation has changed and I do agree but still during every month my loved ones turns into untouchables beings.
Physicians are humans too!
To err is human. People make mistakes. Clinicians are no exception. But as soon as a patient or a person enters a doctor’s room, he or she forgets that the doctor too is a human being and expects too much from him or her.