Do some cultures have their own ways of going mad?

English: Pic of the DSM-IV English: My wife re...

I have always been interested in the so-called culture-bound syndromes, having come to psychiatry from cross-cultural studies as I did. Throughout my teaching career, I have always found the opportunity to  lecture on these disorders, since they are so bizarre and colorful. But I have not shared the sense that there are ‘unique’ ways of going mad in other cultures that are outside the framework of Western psychiatry’s official diagnoses embodied in the Diagnostic and Statistical Manual, or DSM. This is not, however, because I feel everyone’s distress fits neatly into the predefined pigeonholes. It is, on the other hand, that, the more I look, the more I feel that nobody fits the pigeonholes neatly, even psychiatric patients within my own culture. There are as many individual ways of going mad as there are distressed people. As someone once said (I’m paraphrasing),  it is much more important to get to know who the person is that has the disease than what the disease is that the person has. (via Boston Globe).

In more DSM-related news, independent website DSM Watch was served with a cease-and-desist order by the American Psychiatric Association’s legal dept. to stop it from continuing to use the DSM name. Vaughan Bell, of the excellent Mind Hacks weblog, scratches his head over the rationale for this. And Mind Hacks also points to this excellent summary of DSM in a hundred words from the British Journal of Psychiatry:


American Psychiatric Association

“DSMis an American classification system that has dominated since 1980. It is disliked by many for reducing diagnostic skills to a cold list of operational criteria, yet embraced by researchers believing that it represents the first whiff of sense in an area of primitive dogma. It has almost foundered by confusing reliability with validity but the authors seem to recognise its errors and are hoping for rebirth in its 5th revision due in May 2013. The initials do not stand for Diagnosis as a Source of Money or Diagnosis for Simple Minds but the possibility of confusion is present.” 

And Allen Frances,one of the shapers of DSM-IV who has become a sort of Don Quixote tilting at the windmills of the revision process leading up to the May 2013 arrival of DSM-V,  writes in the Huffington Post, Preventive Psychiatry Can Be Bad for Our Health:

“Preventive psychiatry may someday be of significant service in reducing the burden of human suffering — but only if it can be done really well. And the sad truth is that we don’t yet have the necessary tools. More people will be harmed than helped if psychiatry stretches itself prematurely to do what is currently well beyond its reach. That’s what is so scary about the unrealistic prevention ambitions of DSM-5, the new manual of mental disorders now in preparation and set to become official in 2013. DSM-5 proposes a radical redefinition of the boundaries of psychiatry, giving it the impossible role of identifying and treating mental disorders in their nascent stages before they have fully declared themselves. Tens of millions of people now deemed normal would suddenly be relabeled mentally disordered and subjected to stigma and considerable risks consequent to inappropriate treatment.”