Culture in psychiatric diagnosis: an issue of scientific accuracy.

The revised version of the third edition of the American Psychiatric Association's (1987) Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R) gives scant attention to the significance of culture. Two paragraphs in the Introduction advising caution when using the Manual in different cultures (pp. xxvi-xxvii) are followed by more than 500 pages in which the relevance of culture remains basically unrecognized. This neglect is problematical: Ethnological research has repeatedly demonstrated the cultural plasticity of human behavior, so much so, in fact, as to controvert the unqualified attribution of psychiatric meaning to symptoms or sets of symptoms (Rogler, 1993). Yet, despite the scant attention given to culture, the DSM-III and its revised version are more widely used cross-nationally in teaching, research, and clinical practice than any other system for classifying mental illnesses (Maser et al. 1991).