Sullivan, Roger J.; Allen, John S.; Nero, Karen L.
Abstract
The Republic of Palau in the western Pacific has one of the highest rates of schizophrenia diagnoses in the world today. The expression of schizophrenia in Palau and greater Micronesia is also extraordinarily gendered, with rates of affliction approximately two times higher among males. This study uses contemporary clinical diagnostic and research tools to consider and reject the hypotheses that schizophrenia in Palau has a unique diagnostic profile, that it has a unique bio-behavioral expression, and that it is a consequence of “development” manifest in the introduction and use of psychoactive drugs. These results are used to critique an assumption that has emerged from previous cross-cultural research-that the expression of schizophrenia is necessarily more benign in “developing” settings-and to suggest that aspects of historical and contemporary social practices may contribute to a gender imbalance in the expression of symptoms of schizophrenia in this Pacific Island nation.
