Long-term non-catatonic mutism in schizophrenia: cultural influences

ABSTRACT Selective mutism stemming from social anxiety is not rare in childhood and can also occur, though less frequently, in adulthood. Mutism can be one component of a catatonic syndrome but it can also occur, as reviewed in this paper, as a symptom in non-catatonic schizophrenic illness. Reviewing mutism in non-catatonic schizophrenia in the Google Scholar database (1995–2015), a large majority of reports originate in the Indian subcontinent, which raises the question of what this symptom might mean from a perspective of culture, ethnicity and religion. Silence is valued in many cultures and is an integral part of many religious rites but appears to have special spiritual value in India, which may explain the prevalence in that country of long-term mutism in the context of schizophrenia. Mutism manifesting in other diagnostic categories may also be prevalent in India, but perhaps less likely to come to psychiatric attention. A case history of prolonged non-catatonic mutism in an Orthodox Jewish woman with schizophrenia is included, an exception that perhaps proves the rule because silence is also of great spiritual significance in Orthodox Judaism. The psychological uses of silence and the value one’s culture places on silence appear to determine the symptom of mutism.