Cultural Aspects of Psychiatric Disorders
From the outset, psychopathological research has usually assumed that mental disorders exist as “objective’’ states and can be evalu-ated with universal and standardized criteria, forgetting, in part, the impact of social, economic, cultural, and political factors in the explanation of psychopathological disorders. This oversight is all the more critical when comparing culturally distinct groups. How-ever, in the last 30 years this oversight has been mitigated by signif-icant contributions in cross-cultural research, whose objective has been to understand the cultural component of psychopathology.
This research, which has increased dramatically since the 1970s and 1980s, was consolidated via the creation of a group working on cross-cultural studies for the preparation of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV-TR) (American Psychiatric Association, 1994; Mezzich et al., 1993). The Manual contains three kinds of information relating to cultural factors: 1) in the clinical presentation of disorders, a discussion of cultural variants of each disorder, called symptoms dependent on culture and gender; 2) guidelines for a “cultural formulation’’ of the clinical presentation to help clinicians perform a culturally sensitive diagnosis; and 3) a description of “culture-bound’’ syndromes, including the name of the disorder, the cultures in which it has been diagnosed, and a brief description of the psychopathology associated with each clinical presentation (the last two sections are included in Appendix I of the DSM-IV-TR). The ICD-10 has also been revised and updated to account for cultural factors, as evidenced by the emergence of new diagnostic systems such as the Chinese Classifi cation of Mental Disorders and the Latin American Guide for Psychiatric Diagnosis (Berganza et al., 2001; Mezzich et al., 2001). While both of these culturally sensitive diagnostic manuals recognize the value of local cultural requirements to enhance the validity of psychiatric diagnosis, they also illustrate the complementary need to integrate such systems of diagnosis into a global and reliable diagnostic language (Lee, 1993; Berganza et al., 2001).
The existence of a rich modern tradition of cross-cultural research and debate led directly to the increased attention to cul-tural factors in DSM-IV-TR. In turn, the publication of the man-ual stimulated continued research on the influence of cultural factors on the etiology, symptomatology, course and treatment outcome of psychopathological disorders.