Challenging the Myth of a Culture Free Nosological System

Abstract

Despite the existence of a voluminous and continuously growing literature indicating that cultural factors exert profound influences on psychopathology and psychiatric nosology, until most recently, culture had been practically completely neglected in most discussions on psychiatric diagnosis by the majority of psychiatric theorists, researchers and practitioners (Jensen & Hoagwood, 1997; Mezzich, Kleinman, Fabrega, & Parron, 1996). In this regard, the publication of the fourth version of the Diagnostic and Statistical Manual (DSM-IV) (American Psychiatric Association, 1994) represented a remarkable and encouraging departure. Thanks to the dedicated work of the Group on Culture and Diagnosis (GCD), and the receptive attitude of the leaders of the DSM-IV Task Force, the final version of the DSM-IV is indeed much more culturally informed and enriched as compared to its previous incarnations. As summarized in a recent article by Mezzich et al. (1997), although the Task Force’s acceptance of GCD’s recommendations was partial, inconsistent, and at times superficial, the final product does contain a substantial amount of cultural information that is overall useful for clinicians and researchers who consult the manual and related materials. These include: 1) the incorporation of a discussion on the role that culture plays in psychiatric diagnosis in the Introduction section of the Manual; 2) the inclusion of cultural information, where relevant, in most sections of the text; 3) outline for Cultural Formulation; 4) glossary of Culture Bound Syndromes (CBS). The last two are included in the DSM-IV as an Appendix.