Culturally sensitizing psychiatric diagnosis. A framework for research.

The convergence between the demystification of psychiatric diagnosis and the increasing professional awareness of a cultural viewpoint offers the opportunity for research to systematically address issues of culturally valid diagnosis. To organize such research, a three-level hierarchical framework is developed which integrates hypotheses about the role of culture, beginning with symptom assessment, then the configuring of symptoms into disorders, and finally the interpersonal situation of the diagnostic interview. An examination of cross-cultural research and research on cultural minorities shows how errors accumulate from the first to the third level because of the neglect of culture or through misconceptions of the concept. The framework is premised upon the need to make programs of research the driving force behind long-range efforts to culturally sensitize psychiatric diagnosis.