Culture and Psychopathology: Foundations, Issues, Directions

Abstract

The present article offers an overview of the historical influences, conceptual assumptions, and major findings and issues associated with the study of culture and psychopathology. The article traces continuing reductionistic resistance to the incorporation of cultural considerations in the etiology, expression, and treatment of psychopathology to historical and contemporary forces. These forces include ‘cultural context’ of Western psychiatry and psychology, which choose to locate the determinants of behaviour in the human mind and brain. A definition of culture that acknowledges its internal and external representations is offered, and steps in the cultural construction of reality are proposed. Within this context, the risks of imposing Western cultural views universally are noted, especially attempts to homogenise classification and diagnostic systems across cultures. ‘Culture-bound’ disorders are used as example of Western bias via the assumption that they have ‘real’ disorders, while the other cultures have disorders that are shaped by culture. Cultural considerations in understanding the rate, etiology, and expression are presented, including recommended criteria for conducting epidemiological studies across cultural boundaries, especially ‘schizophrenic’ disorders as this problematic diagnostic category is subject to multiple cultural variations. The article closes with discussions of ‘cultural competence’ and ‘multilevel’ approaches to behaviour.