The Impact of Cultural Beliefs in Paranoid Schizophrenia: A Case Report

Abstract: Background: Schizophrenia is a chronic psychiatric disorder with clinical manifestations often influenced by sociocultural factors. In societies where beliefs in ancestral spirits and mystical phenomena are deeply ingrained, psychotic symptoms may take culturally specific forms. Understanding these cultural contexts is essential for accurate diagnosis and effective, patient-centered care. Case Presentation: We report a case of a 36-year-old Balinese male diagnosed with paranoid schizophrenia, whose psychotic symptoms were strongly influenced by the local cultural concept of melik. The patient experienced persistent delusions of spiritual possession, believing himself to be spiritually unique and targeted by black magic. He also reported daily auditory hallucinations instructing him on various actions. These symptoms caused significant distress and impaired his ability to function normally. Treatment included pharmacological intervention with risperidone and culturally sensitive supportive psychotherapy to address both the psychopathology and the culturally embedded beliefs. Discussion: Although the patient’s beliefs were consistent with the culturally accepted notion of melik, they also displayed hallmark features of psychosis—loss of reality testing, fixed non-negotiable delusions, and functional decline. The DSM-5 Cultural Formulation Interview underscores the importance of differentiating between culturally normative experiences and pathological symptoms. In this case, incorporating cultural understanding into the clinical assessment facilitated accurate diagnosis and guided a respectful yet effective treatment approach. Conclusion: This case underscores the importance of cultural sensitivity in the evaluation and management of psychosis, allowing clinicians to distinguish between culturally normative beliefs and psychopathology, thereby ensuring both empathy and diagnostic accuracy. Keywords: Schizophrenia, Paranoid schizophrenia, Cultural beliefs, Melik, DSM-5. Title: The Impact of Cultural Beliefs in Paranoid Schizophrenia: A Case Report Author: Kadek Ratih Pradnyaswari, Komang Wiswa Mitra, I Dewa Gede Basudewa, I Ketut Arya Santosa International Journal of Healthcare Sciences ISSN 2348-5728 (Online) Vol. 13, Issue 1, April 2025 - September 2025 Page No: 502-506 Research Publish Journals Website: www.researchpublish.com Published Date: 25-July-2025 DOI: https://doi.org/10.5281/zenodo.16419608 Paper Download Link (Source) https://www.researchpublish.com/papers/the-impact-of-cultural-beliefs-in-paranoid-schizophrenia-a-case-report