Is a mental illness a mental illness no matter where in the world its diagnosed? Does culture influence the severity and nature of the diagnosis?

Yes and no. Culture does and doesnt matter.

Cultural relativism is being broadly applied today, and it influences everything from education to small business loans. Does it have a place in psychiatry?

A universalist approach insists disorders ranging from bipolar disorder and schizophrenia to generalized anxiety disorder and ADHD share diagnostic criteria and treatment outcomes no matter where in the world people with mental illness are surveyed.

Adherents to a relativistic approach claim all of these things are influenced by culture, and to apply western theories and treatments of psychiatry across cultures is incorrect.

An exhaustive review of research considered whether psychiatric diagnoses are universal or vary across cultures. They found that while the expression of symptoms may vary, actual diagnoses, percentage of people affected, and responsiveness to treatment are universal.

The authors of the report offer several relevant case studies. In one they found that significantly more parents sought help for children who seemed distracted in school and unable to focus in Hong Kong than in the United States. These are typical symptoms of ADHD.

When assessed for ADHD under DSM IV criteria, the rate of children with the disorder and the success of standard medical treatment was the same in both cultures. The difference was that parents in Hong Kong are less tolerant of differences in child behavior and more focused on attentive accomplishment in school. More of them thought something was wrong with their child.

In another example a common psychiatric diagnosis in Puerto Rico is nerve attacks. While 26% of people who seek psychiatric care on the island are given this diagnosis, it has no equivalent in non-Latino cultures. Or so we thought.

Nerve attacks is characterized by uncontrollable sadness and crying along with outbursts of anger and disabling phobias. When examined by doctors from outside of Puerto Rico the diagnosis became major depressive disorder comorbid with anxiety disorder.

When people with a diagnosis of nerve attacks were treated for MDD and anxiety their conditioned improved with the same rate of success we find across the United States.

The universalist approach which applies DSM criteria to diagnosis and combines that with evidence-based treatment held across cultures. Relativism was only relevant in the way symptoms were reported and described.

The more biologically-based the disorder, like schizophrenia or fragile X, the more consistently this discovery held. While tolerance for various behaviors varies across cultures, actual illnesses seem very similar.

While culture must be considered when the patient first presents, if accurately diagnosed a mental illness is a mental illness, and must be treated as diagnosed, no matter where in the world, or in diverse local cultures, it expresses itself. Treatment may consider local customs – in parts of Africa antipsychotics are administered as part of a ritual with tribal faith healers who work in conjunction with psychiatrists – but we must encourage people in diverse cultures to accept well-researched and effective treatment for mental illness.

No matter what it’s called and where it’s called it, mental illness does not need to result in diverse groups of people suffering due to cultural constraints.

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