Culture and Psychopathology

The importance of understanding the cultural context of psychopathology
cannot be overstated. To be sure, some disorders that span populations—
depression, mental retardation, and schizophrenia are examples—but a
population both defines what should be considered abnormal behavior and
determines how psychopathology is expressed. “Cultural relativism” refers
to the fact that abnormality is relative to its cultural context; the same behavior
or set of beliefs can be viewed as abnormal in one population and perfectly
familiar and normal in another population. When viewed from an
American perspective, the remedies, rituals, and beliefs of a witch doctor
may seem to reflect some disorder within the witch doctor rather than a valued
and culturally sanctioned means of treatment within that culture. No
doubt members of a given tribal population in South America may regard
the behavior of North American adolescents on prom night as grossly abnormal.
Some disorders only exist in certain cultures. A disorder known as
pibloktoq occurs in Eskimo communities. The symptoms include tearing off
one’s clothes, shouting obscenities, breaking furniture, and performing
other irrational and dangerous acts. The afflicted individual often follows
this brief period of excited behavior by having a seizure, falling into a coma
for twelve hours, and, upon awakening, having no memory of his or her behavior.
Some disorders may be very similar across two populations but contain a cultural twist. For instance, in the United States, the essential feature of social
anxiety disorder is a fear of performance situations that could lead to
embarrassment and disapproval. In Japan and Korea, the main concern of
people with social anxiety disorder is the fear that one’s blushing, eye contact,
or body odor will be offensive to others.

There are numerous examples of culturally based psychopathologies; the
DSM-IV-TR lists twenty-five of them in an appendix. Moreover, throughout
the manual, a brief statement accompanies the description of most disorders
on the roles of ethnic and cultural factors that are relevant for the given
disorder, which can help the clinician arrive at an accurate diagnosis. 680