A developmental and psychobiologic framework for understanding the role of culture in child and adolescent psychiatry.

In summary, despite these widely accepted interdisciplinary perspectives on the role of culture, the DSM framework lacks a culturally meaningful usage. For Kleinman, the changes on culture in the DSM-IV were "too little, too late." The cultural formulation and a glossary of culture-bound syndromes were included in its appendix. The acceptance by the DSM-IV task force of the notion of cultural variations in clinical presentation of disorders may be reflective of changes to come in the future. The current DSM-IV has more of a descriptive psycho-pathologic approach rather than an integrated cross-cultural, psychobiologic, developmental approach, however. The developmental perspective in psychiatry is emerging as a "bridge" for consilience through evidence-based scientific understanding and conciliation through clinical practice. This perspective is unique because it is intrinsic to different aspects of psychiatry. It readily accommodates the descriptive-empirical model by means of concepts borrowed from developmental psychopathology and psychobiology. These concepts include normalcy, life cycle, risk and resilience, and protective mechanisms within a dynamic construction of development that involves an interchange among biology-person-society-culture. The developmental perspective also can make important contributions to a process-oriented approach to measurement beyond a textually defined DSM structure. The developmentally operationalized dimensional constructs offer to expand psychiatry's domains beyond diagnosable conditions and illness boundaries. The developmental perspective argues for early preventive and therapeutic interventions for a broad array of applications based on demonstrated evidence of efficacy. Finally, the developmental perspective with its social and cultural contexts is an intrinsic complement to Kandel's framework for an expanded training of psychiatrists in the neurosciences and the associated innovative technologies for understanding the mechanism of structural and functional changes in the brain in various contexts and categories.