Cross-Cultural Psychiatry and Validity in DSM-5

Abstract

The latest edition of the American Psychiatric Association’s Diagnostic and Statistical Manual, DSM-5, explicitly addresses the possibility of cultural variation in mental illness. Among other things, it contains a ‘Glossary of Cultural Concepts of Distress’, which describes nine common conditions, including khyal cap, or ‘wind attacks’, a syndrome found among Cambodians in the United States and Cambodia. The chapter examines three possible models of the relation between such cultural idioms and the ambition, for DSM-5, of being a valid taxonomy of universal forms of mental illness. The models are (1) an underlying universal ‘pathogenic’ component overlain by a variable ‘pathoplastic’ cultural shape, (2) a pathogenic-only model, and (3) a pathoplastic-only model. None, however, reconciles the DSM’s simultaneous ambitions of validity and cultural sensitivity and suggest that the ‘Glossary of Cultural Concepts of Distress’ remains an afterthought in tension with the rest of the taxonomy.