Culture and history in psychiatric diagnosis and practice.

A brief review of the history of Western psychiatry underscores how happenings in Anglo European societies during the early modern and modern era impacted on regional populations in the midst of profound demographic, social and political economic change. Such factors along with cultural conventions created an amalgam of behavior problems: social responses to these under the aegis administrative bodies gave rise to the discipline and profession of psychiatry. Central tenets that we take for granted as facts about psychiatric disorders (e.g., their manifestations, natural history, diagnosis) were shaped by historical and cultural influences. Psychiatry may outline a science of the psyche and its disturbances but it also reflects a cultural interpretation about personal experience, responsibility, social behavior, and the requirements for social order. The cultural character of the psychiatric enterprise itself, just as much as the characteristics of its disorders, constitute the subject matter of cultural psychiatry. Events during the late eighteenth and nineteenth centuries in Anglo European societies gave rise to psychiatry. First, there took place the differentiation of psychiatric disorders from the pool of human social and behavior problems. Second, and in relation to this, a segment of the medical profession was accorded (or appropriated) a social mandate and acquired an obligation to treat victims of mental disorders. The historical sociology of psychiatry constitutes one aspect of cultural psychiatry. The second covers developments during the latter part of the twentieth century. At this juncture, psychiatry became the target of labeling theorists in sociology, cultural relativists in anthropology, antipsychiatrists from within the discipline itself, and revisionist and critical historians of psychiatry. An outgrowth of this is the perspective that underscores the important role played by values, ideas, and world-views in how individuals experience and carry out their lives, phenomena that are critical to the expression, interpretation, diagnosis, and treatment of psychiatric disorders. That the science and practice of modern psychiatry incorporate an ethnocentric, Anglo European bias or slant on psychopathology is an integral assumption of cultural psychiatry. By describing how other non-Western systems of psychiatry have operated, for example, their theories and practices, one gains a further appreciation of the important role of culture in shaping Western psychiatry. This is taken up in an article by Fàbrega elsewhere in this issue where concepts and practices of traditional Chinese and Indian medicine that pertain to mental health and illness are reviewed.