This paper asks what it means to say that a disorder is a “real” disorder and then considers whether culture-bound syndromes are real disorders. Following J.L. Austin I note that when we ask whether some supposed culture-bound syndrome is a real disorder we should start by specifying what possible alternatives we have in mind. We might be asking whether the reported behaviours genuinely occur, that is, whether the culture-bound syndrome is a (...) genuine phenomenon as opposed to a myth. We might be wondering whether the condition should rightly be considered a disorder, as opposed to some sort of non-disorder condition. We might want to know whether the culture-bound syndrome is really a distinct disorder, in the sense that scientific classification systems should include it as a separate category, or whether it is just a variant of a universally occurring disorder. I argue that some specific difficulties can arise with determining whether a culture-bound syndrome is a real disorder in each of these three senses. However, the frequent assumption that real disorders will necessarily occur universally, and that those that occur only in certain environments are suspicious is not generally justified. (shrink)

This paper aims to show that the classification by the American Psychiatric Association in the Diagnostic and Statistical Manual of Mental Disorders of a distinct listing of disorders known as Culture-Bound Syndromes is misguided. I argue that the list of CBS comprises either genuine disorders that should be included within the main body of the DSM; or ersatz-disorders that serve a practical role for psychiatrists dealing with patients from certain cultures but will one day be eliminated or assimilated (...) by bona fide DSM classifications. In support of these views I draw on claims from two key themes in the philosophy of science: the claim that all folk explanations for phenomena are thoroughly theoretical and therefore fallible; and the occurrence of theoretical elimination in the history of science. I contend that any ersatz-disorders located in the DSM that are judged to be radically false do not differ in kind from eliminated theories in the history of pre-science. (shrink)

This article examines the development of koro’s epistemic status as a paradigm for understanding culture-specific disorders in modern psychiatry. Koro entered the DSM-IV as a culture-bound syndrome in 1994, and it refers to a person’s overpowering belief that his genitalia is retracting and even disappearing. I focus in particular on mental health professionals’ competing views of koro in the 1960s—as an object of psychoanalysis, a Chinese disease, and a condition predisposed by culture. At that critical juncture, (...) transcultural psychiatrists based outside of continental China—namely, Taiwan, Hong Kong, and Singapore—appropriated ideas from traditional Chinese culture to consolidate the clinical diagnosis of koro as culture-bound. This new global meaning of koro was made possible by a cohort of medical experts who encountered the phenomenon and its sufferers in Sinophone communities, but placed their contributions within the broader contours of the global reach of Anglophone psychiatric science. (shrink)

The story of the body. Fay Bound Alberti takes the human body apart in order to put it back anew, telling the cultural history of our key organs and systems from the inside out, from blood to guts, brains to sex organs.

Premenstrual dysphoric disorder was recently moved to a full category in the DSM-5 . It also appears set for inclusion as a separate disorder in the ICD-11 . This paper argues that PMDD should not be listed in the DSM or the ICD at all, adding to the call to recognise PMDD as a socially constructed disorder. I first present the argument that PMDD pathologises understandable anger/distress and that to do so is potentially dangerous. I then present (...) evidence that PMDD is a culture-bound phenomenon, not a universal one. I also argue that even if medication produces a desired effect, there are biological correlates with premenstrual anger/distress, such anger/distress seems to occur monthly, and women are more likely than men to be diagnosed with affective disorders, none of these factors substantiates that premenstrual anger/distress is caused by a mental disorder. I argue that to assume they do is to ignore the now accepted role that one’s environment and psychology play in illness development, as well as arguments concerning the social construction of mental illness. In doing so, I do not claim that there are no women who experience premenstrual distress or that their distress is not a lived experience. My point is that such distress can be recognised and considered significant without being pathologised and that it is unethical to describe premenstrual anger/distress as a mental disorder. Further, if the credibility of women’s suffering is subject to doubt without a clinical diagnosis, then the way to address this problem is to change societal attitudes towards women’s suffering, not to label women as mentally ill. The paper concludes with some broader implications for women and society of the change in status of PMDD in the DSM-5 as well as a sketch of critical policy suggestions to address these implications. (shrink)

Cognition in living entities—and their social groupings or institutional artifacts—is necessarily as complicated as their embedding environments, which, for humans, includes a particularly rich cultural milieu. The asymptotic limit theorems of information and control theories permit construction of a new class of empirical ‘regression-like’ statistical models for cognitive developmental processes, their dynamics, and modes of dysfunction. Such models may, as have their simpler analogs, prove useful in the study and re-mediation of cognitive failure at and across the scales and levels (...) of organization that constitute and drive the phenomena of life. These new models particularly focus on the roles of sociocultural environment and stress, in a large sense, as both trigger for the failure of the regulation of bio-cognition and as ‘riverbanks’ determining the channels of pathology, with implications across life-course developmental trajectories. We examine the effects of an embedding cultural milieu and its socioeconomic implementations using the ‘lenses’ of metabolic optimization, control system theory, and an extension of symmetry-breaking appropriate to information systems. A central implication is that most, if not all, human developmental disorders are fundamentally culture-bound syndromes. This has deep implications for both individual treatment and public health policy. (shrink)

While some of mental disorders due to emotional distress occur cross-culturally, others seem to be much more bound to particular cultures. In this paper, I propose that many of these “cultural syndromes” are culturally sanctioned responses to overwhelming negative emotions. I show how tools from cultural evolution theory can be employed for understanding how the syndromes are relatively confined to and retained within particular cultures. Finally, I argue that such an account allows for some cultural syndromes to be or (...) become mental disorders and also steers clear of some of the anti-realist trappings associated with a social constructivism of cultural syndromes. (shrink)

The DSM-III, DSM-IV, DSM-IV-TR and ICD-10 have judiciously minimized discussion of etiologies to distance clinical psychiatry from Freudian psychoanalysis. With this goal mostly achieved, discussion of etiological factors should be reintroduced into the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. A research agenda for the DSM-V advocated the "development of a pathophysiologically based classification system". The author critically reviews the neuroevolutionary literature on stress-induced and fear circuitry disorders and related amygdala-driven, species-atypical fear behaviors of clinical severity in adult (...) humans. Over 30 empirically testable/falsifiable predictions are presented. It is noted that in DSM-IV-TR and ICD-10, the classification of stress and fear circuitry disorders is neither mode-of-acquisition-based nor brain-evolution-based. For example, snake phobia and dog phobia are clustered together. Similarly, research on blood-injection-injury-type-specific phobia clusters two fears different in their innateness: 1) an arguably ontogenetic memory-trace-overconsolidation-based fear and 2) a hardwired fear of the sight of one's blood or a sharp object penetrating one's skin. Genetic architecture-charting of fear-circuitry-related traits has been challenging. Various, non-phenotype-based architectures can serve as targets for research. In this article, the author will propose one such alternative genetic architecture. This article was inspired by the following: A) Nesse's "Smoke-Detector Principle", B) the increasing suspicion that the "smooth" rather than "lumpy" distribution of complex psychiatric phenotypes may in some cases be accounted for by oligogenic transmission, and C) insights from the initial sequence of the chimpanzee genome and comparison with the human genome by the Chimpanzee Sequencing and Analysis Consortium published in late 2005. Neuroevolutionary insights relevant to fear circuitry symptoms that primarily emerge overconsolidationally are presented. Also introduced is a human-evolution-based principle for clustering innate fear traits. The "Neuroevolutionary Time-depth Principle" of innate fears proposed in this article may be useful in the development of a neuroevolution-based taxonomic re-clustering of stress-triggered and fear-circuitry disorders in DSM-V. Four broad clusters of evolved fear circuits are proposed based on their time-depths: 1) Mesozoic circuits hardwired by wild-type alleles driven to fixation by Mesozoic selective sweeps; 2) Cenozoic circuits relevant to many specific phobias; 3) mid Paleolithic and upper Paleolithic circuits ; 4) Neolithic circuits. More importantly, the author presents evolutionary perspectives on warzone-related PTSD, Combat-Stress Reaction, Combat-related Stress, Operational-Stress, and other deployment-stress-induced symptoms. The Neuroevolutionary Time-depth Principle presented in this article may help explain the dissimilar stress-resilience levels following different types of acute threat to survival of oneself or one's progency. PTSD rates following exposure to lethal inter-group violence are usually 5-10 times higher than rates following large-scale natural disasters such as forest fires, floods, hurricanes, volcanic eruptions, and earthquakes. The author predicts that both intentionally-caused large-scale bioevent-disasters, as well as natural bioevents such as SARS and avian flu pandemics will be an exception and are likely to be followed by PTSD rates approaching those that follow warzone exposure. During bioevents, Amygdala-driven and locus-coeruleus-driven epidemic pseudosomatic symptoms may be an order of magnitude more common than infection-caused cytokine-driven symptoms. Implications for the red cross and FEMA are discussed. It is also argued that hospital phobia as well as dog phobia, bird phobia and bat phobia require re-taxonomization in DSM-V in a new "overconsolidational disorders" category anchored around PTSD. The overconsolidational spectrum category may be conceptualized as straddling the fear circuitry spectrum disorders and the affective spectrum disorders categories, and may be a category for which Pitman's secondary prevention propranolol regimen may be specifically indicated as a "morning after pill" intervention. Predictions are presented regarding obsessive-compulsive disorder and "culture-bound" acute anxiety symptoms. Also discussed are insights relevant to pseudoneurological symptoms and to the forthcoming Dissociative-Conversive disorders category in DSM-V, including what the author terms fright-triggered acute pseudo-localized symptoms. Speculations based on studies of the human abnormal-spindle-like, microcephaly-associated gene, the microcephaly primary autosomal recessive gene, and the forkhead box p2 gene are made and incorporated into what is termed "The pre-FOXP2 Hypothesis of Blood-Injection-Injury Phobia." Finally, the author argues for a non-reductionistic fusion of "distal neurobiology" with clinical "proximal neurobiology," utilizing neurological heuristics. It is noted that the value of re-clustering fear traits based on behavioral ethology, human-phylogenomics-derived endophenotypes and on ontogenomics can be confirmed or disconfirmed using epidemiological or twin studies and psychiatric genomics. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 10.1 (2003) 25-27 [Access article in PDF] Gender, Body, Meaning:Anthropological Perspectives on Self-Injury and Borderline Personality Disorder Carolyn Sargent THE CENTRAL THEMES OF "Commodity Body/Sign: Borderline Personality Disorder and the Signification of Self-Injurious Behavior" reflect issues that cut across the disciplines represented by this journal and have received increasing attention from anthropologists. Medical anthropologists, as well as psychological anthropologists and others interested in (...) symbolic analysis of the body, have addressed such topics as the culture of biomedicine and the cultural shaping of psychiatric classification, the multiple meanings of body modifications, power relations in therapeutic interactions between doctor and patient, and cultural variation in understandings of normality and abnormality.Curiously, there is little anthropological literature that directly focuses on either borderline personality disorder (BPD) or self-injurious acts per se. Indeed anthropological research on psychiatric diagnosis, classification, and treatment, as well as ethnopsychiatry, include scant reference to personality disorders. One exception is Nuckolls' 1992 article, "Toward a Cultural History of the Personality Disorders," which raises pertinent questions for one of Potter's introductory statements—that the majority of those diagnosed with BPD are women. Nuckolls directly addresses gender ideology and gender roles in the United States in his comparison of antisocial personality and histrionic personality diagnoses. In his paper, he argues that these personality disorders have cultural histories and are strongly congruent with prevailing gender stereotypes, such that men are many times more likely to be diagnosed as antisocial than women and women much more likely to be diagnosed as histrionic (Nuckolls 1992, 37). He also historicizes the emergence of certain behavioral styles that have been seen as characteristic of women and men, and the evolution of psychiatric diagnoses that classify extreme manifestations of these behavioral styles.The issue of why women, rather than men, are more frequently diagnosed with BPD is not elaborated in Potter's article, although she notes the importance of considering the intersection of gender and "identifying behaviors" associated with BPD. Cultural analyses of gender ideology in the [End Page 25] United States might suggest that the connection involves gendered expectations concerning emotionality and relational context but these articulations remain intriguing and underexplored. One might speculate that BPD/self-injury occurs in the context of particular gender ideologies, perhaps in class-based, industrialized societies where the body is highly commodified. It appears that the history of this constellation of symptoms and behaviors remains to be written.Cultural analysis of self-injury, a theme that runs through Potter's article, tends to be embedded in the anthropological literature on body ornamentation, initiation rituals, and "culture-bound" syndromes. Mascia-Lees and Sharpe (1992, 1) describe the body as "a site of adornment, manipulation, and mutilation," practices with roots reaching back as far as 30,000 years, and include as examples head deformation, scarification, foot binding, tooth filing, lip plates, nose rings, tattoos, subincision, and genital cutting.However, the concept of self-injury, as Potter notes, is problematic in the discipline of anthropology given the significance historically accorded to cultural relativism. Correspondingly, body "modification" is not "self-injury" as long as it is socially normative, for example, a facet of an initiation ordeal or body ornamentation (e.g., circumcision, scarification, piercing). Among the rare examples of acts that seem readily identifiable as "self-injury" are New Guinea practices of cutting off a finger to demonstrate mourning and Baatombu (West African) male finger amputation to show grief and anger over a wife's infidelity. Both are, however, considered culturally legitimate and not indicative of pathology.Potter's argument draws heavily on the notion of "body as text," derived largely from literary theory and feminist philosophy (Butler 1990; Jaggar and Bordo 1989). The perspective of "body as text" has influenced anthropological theory over the past two decades, particularly in the interpretive and postmodernist schools of thought. The body as a text of femininity is aptly characterized by Bordo, who argues that the continuum between female disorder and normal femininity is revealed by means of an analysis of symbolic meaning of gender in... (shrink)

I propound a mechanistic theory of natural kinds in the human sciences. By examining a culture- bound psychiatric disorder, bulimia nervosa, I illustrate how partially socially constructed phenomena raise a serious challenge to traditional theories of natural kinds. As a solution to the challenge, I show how the mechanistic approach allows us to include real but partly socially sustained phenomena among natural kinds. This is desirable because the theory of natural kinds supplies the human sciences with a (...) clear normative account of concept formation. Furthermore, my theory suggests a conceptual framework for interdisciplinary research on complex phenomena. As a prerequisite for the mechanistic approach, the concept of natural kind in the philosophy of science must be distinguished from the use of the notion in other parts of philosophy. (shrink)

RésuméLes concepts de Ian Hacking ont apporté une contribution importante aux débats dans le domaine de la philosophie de la psychiatrie, qui est aussi au coeur de son Cours au Collège de France. Titulaire de la « Chaire de philosophie et d’histoire des concepts scientifiques » après Michel Foucault, il est l’auteur d’une réflexion sur la classification des troubles mentaux à partir de la problématique des natural kinds. Pour expliquer les cas d’études développés dans son enseignement parisien, nous revenons d’abord (...) sur une série de concepts, pour ensuite poser la question du statut des métaphores scientifiques, et enfin discuter les rapports entre les notions de « maladie mentale transitoire » et de culture-bound syndrome – cette dernière étant issue de la psychiatrie transculturelle canadienne. (shrink)

Progress in neuroscience – notably, on the dynamic functions of neural networks – has deepened our understanding of decision‐making, acquisition of character and temperament, and the development of moral dispositions. The evolution of our cerebral architecture is both genetic and epigenetic: the nervous system develops in continuous interaction with the immediate physical and socio‐cultural environments. Each individual has a unique cerebral identity even in the relative absence of genetic distinction, and the development of this identity is strongly influenced by social (...) and cultural environments leaving major traces in the connectivity of the brain. This interaction introduces important elements of variability and plasticity. Synaptic epigenetic theories of cultural and social imprinting on our brain architecture suggest the possibility that we can be “epigenetically proactive” and adapt our social structures, in both the short and the long term, to benefit and constructively interact with the ever‐developing neuronal architecture of our brains. Epigenetic proaction can be described as a way to socially steer evolution by influencing the cultural imprints to be stored in our brains. The purpose of this article is to present, in a historical and ideological light, the idea that we may culturally shape the developing brain, and discuss some key risks and benefits of this endeavour. The article is a contribution to neuroethics. (shrink)

Sometimes, technological solutions to practical problems are devised that conspicuously take into account the constraints to which a given culture is subjecting the particular task or the manner in which it is carried out. The culture may be a professional culture (e.g., the practice of law), or an ethnic-cum-professional culture (e.g., dance in given ethnic cultures from South-East Asia), or, again, a denominational culture prescribing an orthopraxy impinging on everyday life through, for example, prescribed abstinence (...) from given categories of workday activities, or dietary laws. (shrink)

In this article I argue that the four guiding principles of medical ethics—autonomy, beneficence, non-maleficence, and justice—reflect the values of western culture, but do not necessarily apply outside of it. Western medical practitioners faced with the care of nonwestern patients need to examine their own prejudices in order to accept, not merely tolerate, other values. Acceptance of the other requires that the doctor welcome the patient as one welcomes a guest, openly and equally, with a willingness to listen and (...) to be changed by the encounter. It is through the nurture of trusting relationships that ethical dilemmas in clinical medicine may be resolved, without recourse to the colonial moral hegemony of the principlist approach. (shrink)

Es wird die Frage untersucht, ob die Annahme der Existenz von universellen Normen für die Annäherung der Wissenschaft an die Wahrheit nicht in praxi lediglich Gegenwartszentrismus und Ethnozentrismus heißt. Die griechisch-römische Zivilisation förderte die Wissenschaft durch ihre Demokratie, aber andere Zivilisationen haben sehr wertvolle Datensammlungen geliefert. Die Universalität der Wissenschaft impliziert u. a. daß, wo verschiedene Zivilisationen mit ihren Wissenschaften einander begegnen, sie von einander lernen können.

Asian American women demonstrate higher rates of disordered eating than other women of color and comparable rates to European American women. Research suggests that leading sociocultural predictors, namely pressures for thinness and thin-ideal internalization, are predictive of disordered eating in Asian American women; however, no known studies have tested the intersection of sociocultural and culture-specific variables (e.g., ethnic identity, biculturalism, acculturative stress) to further elucidate disordered eating risk in this vulnerable, understudied group. Accordingly, this project used path analysis to (...) simultaneously examine the role of sociocultural and culture-specific effects on disordered eating in Asian American college women (N = 430). Self-report measures assessing disordered eating, sociocultural (pressures for thinness; thin-ideal internalization) and culture-specific (ethnic identity, biculturalism, acculturative stress) variables revealed that a number of sociocultural and culture-specific factors are predictive of disordered eating. Consistent with prior research, heightened perceived pressures for thinness and thin-ideal internalization were predictive of disordered eating, and thin-ideal internalization partially mediated the relationship between pressures for thinness and disordered eating. Acculturative stress predicted disordered eating and fully accounted for the inverse relationship between biculturalism and disordered eating. Overall, findings highlighted the salience of sociocultural predictors for disordered eating in Asian American women and identified biculturalism and acculturative stress as culture-specific contributors that may uniquely impact vulnerability to disordered eating in Asian American women. Thus, the combined consideration of sociocultural and culture-specific factors may be important in disordered eating research and in the development of individualized treatment plans for Asian American women. (shrink)

Research on bounded rationality has two cultures, which I call ‘idealistic’ and ‘pragmatic’. Technically, the cultures differ on whether they build models based on normative axioms or empirical facts, assume that people's goal is to optimize or to satisfice, do not or do model psychological processes, let parameters vary freely or fix them, aim at explanation or prediction and test models from one or both cultures. Each culture tells a story about people's rationality. The story of the idealistic (...) class='Hi'>culture is frustrating, with people in principle being able to know what they should do, but in practice systematically failing to do it. This story makes one hide in books for intellectual solace or surrender to the designs of someone smarter. The story of the pragmatic culture is empowering: If people are educated to use the right tool in the right situation, they do well. (shrink)

People across cultures consider everyday choices in the context of perceived various external life-determining forces: such as fate and gods (two teleological forces) and such notions as luck and chance (two non-teleological forces). There is little cross-cultural evidence (except for a belief in gods) showing how people relate these salient notions of life-determining forces to prosociality and a sense of well-being. The current paper provides preliminary cross-cultural data to address this gap. Results indicate that choice is the most important life-determining (...) factor. Regression analyses indicate that choice and belief in gods and fate emerged as significant predictors of prosociality towards strangers. Moreover, luck was a significant predictor of decreased prosociality. A relation between life-determining forces and life satisfaction followed the same pattern: choice, gods, and fate emerged as significant predictors of greater life satisfaction, whereas luck was associated with decreased life satisfaction. The overall pattern of results indicates that participants across different cultures might sense being bounded to share or not to care depending on the perceived intentional agency and meaning in the external forces. (shrink)

Clark acknowledges but resists the indirect mind–world relation inherent in prediction error minimization (PEM). But directness should also be resisted. This creates a puzzle, which calls for reconceptualization of the relation. We suggest that a causal conception captures both aspects. With this conception, aspects of situated cognition, social interaction and culture can be understood as emerging through precision optimization.

Although fear and anxiety have gradually become a shared experience in the time of COVID-19, few studies have examined its content from historical, cultural, and phenomenological perspectives concerning the self-awareness and alterity. We discuss the development of the ubiquitous nature of Taijin-kyōfushō (TKS), a subtype of social anxiety disorder (SAD) originated and considered culturally-bound in the 1930s Japan involving fear of offending or displeasing other people. Considering the historical processes of disease classification, advances in cognitive neurosciences, and the (...) need to better understand the content of suffering, psychiatric nosology for SAD still appears controversial and requires further investigations. (shrink)

This special issue of History of the Humane Sciences intends to shed light on a series of psychopathological entities that do not target well defined conditions and experiences, but rather aim at delimiting zones of uncertainty that defy psychopathology’s order of things: mild diagnoses or subthreshold disorders, borderline conditions, culture bound syndromes, or ideas of dimensions and dimensionality. While these categories have come to play an increasingly central role in psychiatric and psychological thinking during the last 50 years, (...) historians and social scientists have had remarkably little to say about how they have been created, what they have been used for, and what kind of realities they have helped to shape. In this introductory article we propose the concept of ‘psychopathological fringes’ to refer to these categories that are located somewhere at the border of psychopathological classifications and refer to zones of conceptual underdetermination. The notion of fringes serves to highlight both the conceptually and the socially marginal nature of the conditions, personal identities, and worlds delimited by these categories. The fringes of psychopathology are zones of vagueness, of epistemic uncertainty, and moral ambiguity. This introduction proposes a first incursion in these zones. It suggests some of the reason why they might have had attracted little interest in the past and why they may be more salient recently. It follows some analytical clues that might help chart a way through it and proposes a map through the collection of articles included in this issue. (shrink)

A review of cultural and historical accounts of anorexia nervosa indicates that this disorder is found primarily in Westernized societies during periods of relative affluence and greater social opportunities for women. Some hypotheses regarding the vulnerability to eating disorders are proposed to the basis of these data.

A review of cultural and historical accounts of anorexia nervosa indicates that this disorder is found primarily in Westernized societies during periods of relative affluence and greater social opportunities for women. Some hypotheses regarding the vulnerability to eating disorders are proposed to the basis of these data.

In lieu of an abstract, here is a brief excerpt of the content:Commentary on “Spiritual Experience and Psychopathology”Francis G. Lu (bio), David Lukoff (bio), and Robert P. Turner (bio)Jackson and Fulford have written an impor-tant paper which addresses an area of increasing interest in the United States—the relationship between religious/spiritual experiences and psychopathology. Using primarily the Present State Examination as the diagnostic framework, the authors describe in rich clinical detail three patients where certain phenomena lead to a possible diagnosis of (...) schizophrenia. However, the patients’ outcomes were uniformly positive—how can this be? The authors argue persuasively for the importance of a contextual assessment “in which psychotic phenomena themselves are embedded in the values and beliefs of the person concerned.” In this commentary, we will first present innovations in the DSM-IV relevant to cultural and religious/spiritual issues, which complement the authors’ conclusions, and then comment upon the paper from this perspective.In the DSM-IV Introduction (1994), a section entitled “Ethnic and Cultural Considerations” provides a rationale for innovations in DSM-IV that better enables its use with culturally diverse individuals: “A clinician who is unfamiliar with the nuances of an individual’s cultural frame of references may incorrectly judge as psychopathology those normal variations in behavior, belief, or experience that are particular to the individual’s culture. For example, certain religious practices or beliefs (e.g., hearing or seeing a deceased relative during bereavement) may be misdiagnosed as manifestations of a Psychotic Disorder” (xxiv). In the introduction, three types of information are cited: 1) sections entitled “Age, Gender and Cultural Considerations” in the text of ninety diagnostic categories discuss clinical variations due to these factors; 2) an Outline for Cultural Formulation designed to assist the clinician in systematically evaluating and reporting the impact of the individual’s cultural context; and 3) a Glossary of Culture-Bound Syndromes. These innovations, based on recommendations of the NIMH Workgroup on Culture, Diagnosis and Care to the Task Force on DSM-IV, are described in extensive detail in an important recent book (Mezzich, Kleinman, Fabrega, and Parron 1996).As an example of the importance of the Age, Gender, and Cultural Consideration section relevant to religious and spiritual experiences, consider the section in the text describing schizophrenia, where the following appears: “Clinicians assessing the symptoms of Schizophrenia in socioeconomic or cultural situations that are different from their own must take cultural differences into account. Ideas that may appear to be delusional in one culture (e.g., sorcery and witchcraft) may be commonly held in another. In some cultures, visual or auditory hallucinations with a [End Page 75] religious content may be a normal part of religious experience (e.g., seeing the Virgin Mary or hearing God’s voice)” (281). Secondly, in the analogous section of the text describing Brief Psychotic Disorder, the following appears: “It is important to distinguish symptoms of Brief Psychotic Disorder from culturally sanctioned response patterns. For example, in some religious ceremonies, an individual may report hearing voices, but these do not generally persist and are not perceived as abnormal by most members of the person’s community” (303).The Outline for Cultural Formulation provides the clinician a concise tool to specify the following information concerning the cultural context that is relevant to clinical care: cultural identity of the individual, cultural explanations of the individual’s illness, cultural factors related to psychosocial environment and levels of functioning, cultural elements of the relationship between the individual and the clinician, and overall cultural assessment for diagnosis and care. Religion is explicitly mentioned in the third section so as to encourage the assessment of “the role of religion... in providing emotional, instrumental, and information support” (1994, 844). This outline for cultural formulation is more fully explicated in a recent chapter by Lu, Lim, and Mezzich (1995).A major innovation in DSM-IV relevant to this topic is the new diagnostic category entitled Religious or Spiritual Problem defined as follows: “This category can be used when the focus of clinical attention is a religious or spiritual problem. Examples include distressing experiences that involve loss or questioning of faith, problems associated with conversion to a new faith, or questioning of spiritual values that may not necessarily be related to an organized... (shrink)

A recent clinical literature on the psychology of cosmetic surgery patients is concerned with distinguishing good from bad candidates. Body Dysmorphic Disorder (BDD) — a mental disorder marked by a pathological aversion to some aspect(s) of one’s appearance — is typically understood in this context as a contra-indication for cosmetic surgery, as it marks those with inappropriate motivation who are unlikely to be satisfied by the surgery’s outcomes. This article uses Foucault’s genealogical work to argue that both the (...) attempt to provide diagnostic conditions for BDD itself, and the broader attempt to demarcate normal and psychopathological concern with appearance are, in part, effects of disciplinary power. Although often presented as a way of making cosmetic surgery more ethical and restrained, this epistemic project inadvertently defends cosmetic surgical interests. Specifically, it contributes to legitimizing the image of an ethically suspect sub-specialty of medicine, and supports its commercial expansion and effective profit-making by displacing its negative sequelae onto patient psyches. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Cultural Context of Post-traumatic Stress DisorderCarolyn Smith-Morris (bio)Keywordspost-traumatic stress disorder (PTSD), culture, medical anthropology, fight-or-flight responseIn his Clinical Anecdote, Dr. Christopher Bailey gamely imagines the evolutionary underpinnings of his patient's distressing lack of war wounds. As part of a careful and engaged discussion of care for his suffering patient, Dr. Bailey suggests that our evolved fight-or-flight response to the alarms of the African savannah may be (...) at work in Colin's distress. The fight-or-flight response is something of great interest to anthropologists, who rely on Darwin's theory of evolution to explain much in human experience. According to Dr. Bailey's application of the theory, Colin's visceral response to threat is protective in the presence of danger, but destructive (particularly to his mental health) in the absence of such challenges. So Dr. Bailey considers whether we may have an evolved “need” for threat, and that Colin's trauma is in part related to the lack of such threat in his wartime experience.According to Darwin's ideas, evolved traits may be adaptive but may also simply be random appearances that have not yet produced cause for evolutionary eradication. The fight-or-flight response, or any of the hypothalamic–pituitary–adrenal axis events initiated under either acute or chronic stress, is therefore occurring in Colin's reactions to everyday frustrations, to wartime exposures, and even during the stressful nontrauma of feeling “wimpy.” Dr. Bailey's idea about an evolved need for threat is tautological. That need is not biological, but cultural.Although post-traumatic stress disorder is medically real, it is an event that develops in a particular place and time. Likewise, gender roles that demand scar battles and trophies of a certain form are culturally determined. Culture is central to this anecdote: a culture-specific occurrence of post-traumatic stress disorder and culturally driven gender roles for men, especially warriors. Stress is indeed present in Colin's life: our postindustrial culture's separation from everyday death and violence make episodes like war and combat all the more shocking or traumatic; the lack of social recognition for his service also seems to be one of Colin's stressors. Both the shock of warfare and the trauma of his social invisibility are as vivid to his evolutionarily informed body as is the presence of a crouching lioness in the room. So it is the host of cultural expectations, and his inability to mobilize social and cognitive resources to respond to them, that is wounding Colin. Talk therapy should draw out these cultural details [End Page 235] and, as Dr. Bailey has already begun to do, emplot Colin into a more heroic (his)story of his service to our nation.Related ArticlesFeature Article: Clinical Anecdotes: A Painful Lack of WoundsCommentary: The Nature of Proof in PsychiatryCommentary: Truth and Healing a Veteran's DepressionCommentary: Inappropriate RegretCommentary: The Cultural Context of Post-traumatic Stress DisorderCommentary: Explication or Explanation?Commentary: The Importance of What Psychiatrists Care AboutCommentary: Mourning or MelancholiaResponse: A Painful Lack of ConnectionCarolyn Smith-Morris Carolyn Smith-Morris is an Associate Professor in the Department of Anthropology at Southern Methodist University in Dallas, Texas. Her work focuses on chronic disease and the health impacts of culture change and acculturative stress in North America. She is engaged in several research programs among migrating Mexican workers, among poor African-Americans in Dallas, and for the Gila (pronounced Hee-la) River Indian Community of Southern Arizona, a tribe that suffers from the highest recorded rates of type 2 diabetes in the world. She also holds a research fellowship with the Foundation for Community Empowerment, serves on the Board of the Society for Medical Anthropology, and is a fellow in the Society for Applied Anthropology. She published Diabetes Among the Pima in 2006 and has several articles detailing her applied research on diabetes, reproduction, health care ethics, and end-of-life care. She can be contacted via e-mail at: [email protected], C. 2009. A painful lack of wounds. Philosophy, Psychiatry, & Psychology 16, no. 3:223–224. [End Page... (shrink)

In order to perceive the world, we need more than just raw sensory input: a subliminal paradigm of thought is required to interpret raw sensory data and, thereby, create the objects and events we perceive around ourselves. As such, the world we see reflects our own unexamined, culture-bound assumptions and expectations, which explains why every generation in history has believed that it more or less understood the world. Today, we perceive a world of objects and events outside and (...) independent of mind, which merely reflects our current paradigm of thought. Anomalies that contradict this paradigm have been accumulated by physicists over the past couple of decades, which will eventually force our culture to move to a new paradigm. Under this new paradigm, a form of universal mind will be viewed as nature’s sole fundamental entity. In this paper, I offer a sketch of what the new paradigm may look like. (shrink)

The embodied human subject is dynamically connected to his or her historico-sociocultural context, the soil from which a person’s psyche is nourished as multiplex meanings are absorbed and enable personal development. In each culture certain towering artistic works embody this perspective. The Dream of the Red Chamber introduces Jia Bao-yu—a scion of the prestigious Jia family—and his relationships with a large cast of characters. Bao-yu is controversial but, at the time of the family’s tragic collapse, he can be seen (...) as embodying a spiritual struggle in which his instinct, nature, sensitivity, and creativity are grounded in his transcendent relationship with a fragment of the world stone, an eternal source of energy and creativity. We are invited to draw on a metaphysical level of thought to consider his struggles with man-made hierarchies and a situated historico-sociocultural order in such a way as to live out his spiritual being. As such, the novel is closely relevant to questions of spirituality in bioethics. Through personal experiences, passions, creativity, and relationships with others, the body is inscribed, forming the soul, which may be misconstrued (for instance, through a medical or Cartesian reformulation of events) but which can be seen as the site of ethical and spiritual thought. (shrink)

There is a long-standing failure to create an ethical culture around substance use disorders (SUDs) or dependence that actively supports people’s recovery efforts. Issues which impede the development of prorecovery environments are complex, but include the far-reaching effects of the social stigma that surrounds SUDs; and the failure to harness relational and social support that allows debates to transcend blaming individual substance users. As part of efforts to create prorecovery environments, it is important to acknowledge that bioethics debate on (...) SUDs is narrow in scope, prioritising topics related to its traditional interests in individual autonomy and novel technologies. As a result, it has not played a significant role in helping to transform the ethical cultures in which substance use recovery takes place. For example, it largely neglects the ethical challenges of developing an empathic, person-centred approach to substance use problems that listens and responds to the voices of clients. It has also participated little in efforts to develop a positive response to reducing the toxic effects of stigma. Indeed, some contributions from the field fan stigma, rather than alleviate it. The aim of this paper is to seed broader ethical debate, in academic literature and lay/professional communities, on how societies should respond to SUDs: steering a course between the critical, but narrow approach of bioethics and the empowerment discourse of evidence-based treatments. (shrink)