Culture, social structure, and quandaries of psychiatric diagnosis: a Vietnamese case study

Immigration and psychopathology: a clinical study

Three groups of 342 Greek, Iberian and Belgian psychiatric patients were compared, matched for sex, age, and time of hospitalization in a university hospital in Brussels. Schizophrenia, schizoaffective disorder/atypical psychosis were diagnosed more among immigrant patients. Somatic anxiety, loss of libido, delusions and hallucinations were symptoms that clinicians observed more in immigrant than in native patients. Atypical symptomatology and change of diagnosis were more likely to occur among immigrant patients. A higher proportion of second generation immigrant patients had a diagnosis of schizophrenia than either the first generation or the Belgians. Male immigrant patients were prescribed anxiolytic drugs more frequently than male natives, but were less likely to be referred to psychotherapy. The authors query whether these findings derive from specificities in the use of psychiatric services and/or from biases in clinicians'attitudes towards patients of different ethnic origin.

The place of culture in DSM-IV

This paper critically reviews the process and outcome of an effort to enhance the cultural validity of DSM-IV and outlines recommendations to improve future diagnostic systems. An ordered presentation of the antecedents and the main phases of this developmental effort is followed by a content analysis of what was proposed and what was actually incorporated, and a conceptual analysis of underlying biases and their implications. The cultural effort for DSM-IV, spearheaded by a scholarly independent NIMH workgroup, resulted in significant innovations including an introductory cultural statement, cultural considerations for the use of diagnostic categories and criteria, a glossary of culture-bound syndromes and idioms of distress, and an outline for a cultural formulation. However, proposals that challenged universalistic nosological assumptions and argued for the contextualization of illness, diagnosis, and care were minimally incorporated and marginally placed. Although a step forward has been taken to introduce cultural elements in DSM-IV much remains to be done. Further culturally informed research is needed to ensure that future diagnostic systems incorporate a genuinely comprehensive framework, responsive to the complexity of health problems in increasingly multicultural societies.