The role of culture on the phenomenology of hallucinations and delusions, explanatory models, and help-seeking attitudes: A narrative review.
Mawada Ghanem, Christian Evangeli-Dawson, Anna Georgiades
Early Intervention in Psychiatry September 1, 2023 DOI: 10.1111/eip.13449 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Narrative review Peer reviewed |
|---|---|
| Sample size | 16 |
| Population | Patients with First Episode Psychosis (FEP) and Non-FEP Schizophrenia |
| Topics | Philosophy of mind |
| Keywords | Culture Delusions Explanatory model Help-seeking Psychosis |
| Citations | 26 |
| Key findings | Cross-cultural differences exist in hallucination and delusion prevalence and in explanatory models of psychosis, which affect help-seeking attitudes and engagement with mental health services. |
Abstract
Culture has been posited to be involved in the formation and maintenance of delusions and hallucinations. The extent of these differences and how they affect explanatory models of psychosis and help-seeking attitudes remains to be understood. This review aims to present a cultural formulation to account for psychosis onset, symptom maintenance, and help-seeking attitudes. A narrative review was conducted to summarize the existing evidence base regarding cross-cultural differences in hallucinatory and delusional prevalence, explanatory models, and help-seeking attitudes in First Episode Psychosis (FEP) and Non-FEP Schizophrenia samples. Sixteen studies were eligible for inclusion. In terms of positive symptom specificity, cross-cultural differences were found. Specifically, auditory and visual hallucinations occurred most frequently in African patients, persecutory and grandiose delusions occurred at higher rates in African, Pakistani, and Latino patients, while delusions of reference were most prevalent in White-British groups. Three explanatory models were identified. Westerners tended to endorse a bio-psychosocial explanation, which was associated with increased help-seeking, engagement, and positive medication attitudes. Asian, Latino, Polish, and Māori patients endorsed religious-spiritual explanatory models, while African patients opted for a bewitchment model. The religious-spiritual and bewitchment models were associated with a longer duration of untreated psychosis (DUP) and poorer engagement with mental health services. These findings highlight the important influence of culture in the formation and maintenance of positive symptoms of psychosis, engagement, and help-seeking attitudes across different ethnic groups. The incorporation of cultural beliefs in formulation development could facilitate enriched CBTp practices and improved engagement amongst different cultural groups with Early Intervention Services.
Comparable studies
Other narrative reviews on philosophy of mind, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| Body Consciousness: A Philosophy of Mindfulness and Somaesthetics | 2008 | Review article | |
| Phenomenology, Structure, and Dynamic of Psychedelic States | 2016 | Review | |
| Classic Hallucinogens and Mystical Experiences: Phenomenology and Neural Correlates. | 2018 | Review | |
| The lived experience of psychosis: a bottom-up review co-written by experts by experience and academics. Individuals with lived experience of psychosis, family members, and carers | 2022 | Co-written bottom-up review | |
| From autopoiesis to neurophenomenology: Francisco Varela's exploration of the biophysics of being. | 2003 | Review |
Citations in the library
Cited by 5
- The Hitchhiker's guide to hallucination research. Consciousness and Cognition November 1, 2025
- [Evolution of views on the phenomenon of spiritual possession within the framework of psychiatric pathology (psychopathological, transnosological and transcultural aspects)]. Zhurnal nevrologii i psikhiatrii imeni S.S. Korsakova 2024
- Voice hearing in refugees survivors of traumatic events Torture Journal December 28, 2023
- Technology-Themed Persecutory and Related Presentations of Delusions in the Digital Age: Narrative Review JMIR Mental Health August 14, 2026
- The Role of Spirituality and Religiosity in the Maintenance and Recovery of Psychosis: A Systematic Review. Early Intervention in Psychiatry July 1, 2025
Cites 4
- Ngā Whakāwhitinga (standing at the crossroads): How Māori understand what Western psychiatry calls "schizophrenia". Transcultural Psychiatry April 2018
- [Psychopathology and phenomenology of religious delusion of possession in schizophrenia]. Zhurnal nevrologii i psikhiatrii imeni S.S. Korsakova 2018
- Experiences of hearing voices: analysis of a novel phenomenological survey. The Lancet Psychiatry March 31, 2015
- Culture and hallucinations: overview and future directions. Schizophrenia Bulletin July 1, 2014