12.3 Psychopathology as universal or relativist.

Culture has the potential of affecting the course and prognosis of mental disorder in several ways. The personal distress felt by a patient is largely mediated by the cultural context. For example cultural beliefs determine how distress is experienced. In one cultural context a psychotic patient may believe he is possessed by harmful spirits, in a different cultural situation the patient accept the cause of distress as an outcome of brain dysfunctions or issues of stress. Culturally limited diagnoses determine how and by whom the symptoms of the disorder is treated whether by appeals to miraculous prayer or in a mental hospital. If mental disorder is believed to be the result of harmful spirits then “healing” can occur when the shaman succeed in driving the spirits out. However, from a Western scientific perspective such “healing” may just be temporary if the real substantial issues causing distress are not part of the treatment objectives (Castillo, 1997). Consequently, in mental illness the issue of whether the etiology is culturally specific or universally prevalent must be evaluated.

The cultural specific position argues that psychopathology is not manifested the same way in different cultures. From this point of view the norms of each society determine how behavior is moderated and the views about mental illness developed in one society are not applicable to other cultural groups. Culture determines what behavior is defined as abnormal since as we noted unusual behavior in one society may be common in another. In addition to differences in definitions of abnormal behavior varying cultures may produce different rates of mental disorder depending on the specific ecological environment and stress found in certain societies but not in other social groups, and from diagnostic identification that may vary with cultural values. Cultural values frame the expression of abnormality leading to a consideration of culture bound symptoms of mental illness. As noted above the belief in spirit possession is common in some societies and schizophrenia and psychotic behavior in general may be attributed to such supernatural forces in these cultural groups. The cultural specific perspective argues that using the common medical model developed in Western science is ethnocentric and forces the psychological reality of cultural majorities on minorities. The power disparity in society and more broadly between countries in the world ensure that it is the values of cultural majorities that will find acceptance (Lewis-Fernandez & Kleinman, 1994). To decide on the relative importance of the cultural specific or universal etiology of mental disorder require cross-culturally valid and reliable ways of measuring and diagnosing mental illness as otherwise comparative studies would have no merit.

Culturally specific researchers and clinicians would maintain that culture and abnormal behavior are totally interdependent and that mental disorder can therefore only be understood within particular cultural frameworks. Other researchers with universal perspectives would argue that there are many similarities in the manifestation of the symptoms of mental illness between cultures, and these cross-cultural similarities should be taken as support for the universality of diagnostic categories (Draguns, 1997). The universal viewpoint argues that psychopathology is largely the same both in etiology and in expression. Many mental disorders appear to have identical symptoms regardless of the culture including schizophrenia, mental retardation and autism. Even the symptoms of postpartum depression in Japan and the U.S. are similar despite distinctive differences in culture (Shimizi & Kaplan, 1987). As we have noted elsewhere in the book the truth about the cause of human behavior including mental illness is found in inclusion of both the cultural and cross-cultural perspectives and not by accepting one viewpoint as opposed to the other.