Culture and Psychiatric Diagnosis

Abstract

This article examines the impact of cultural factors on psychiatric diagnosis, with particular attention to the Diagnostic and Statistical Manual of Mental Disorders (DSM). Since the release of DSM-III in 1980, the operational, symptom-based criteria have sought to establish universal standards for diagnosing mental disorders. However, this approach faces challenges such as diagnostic ambiguity and cultural misalignment. The concept of the "Procrustean bed" underscores the limitations of applying DSM criteria without considering cultural variations, particularly in diagnosing major depression. For instance, in Western cultural contexts heavily influenced by Christianity, guilt is often emphasized as a symptom of depression, although this may be less prevalent in non-Western societies. Comparative studies show that Western patients frequently report guilt and a depressed mood, whereas patients in Asian societies often present with symptoms such as suicidal behavior or illness-related anxiety. This article also explores "culture- bound syndromes," which are mental health conditions shaped by specific cultural contexts, such as hwa-byung (anger syndrome) in Korea and hikikomori (social withdrawal syndrome) in Japan. These syndromes underscore the necessity for culturally adapted diagnostic approaches. For example, hwa-byung, characterized by repressed anger within a patriarchal society, overlaps with DSM-defined depressive and anxiety disorders but maintains a unique cultural expression. Similarly, hikikomori, reflecting extreme social withdrawal exacerbated by the pandemic, is associated with depression and social anxiety. This study advocates for the integration of cultural phronesis or practical wisdom into psychiatry, emphasizing the importance of nuanced and culturally sensitive diagnosis methods. Recognizing alternative symptom expressions, such as anger or shame, in non-Western patients is critical for improving diagnostic accuracy and treatment outcomes.