Last weekend, the latest edition of the Diagnostic and Statistical Manual of Mental Disorders – DSM-5 – was published. The DSM-5 describes the symptoms of a vast range of mental illnesses and is intended as a guide to diagnosis, but the committee has been accused of continually expanding the categories of mental illness, resulting in “diagnostic inflation”.
Moreover, the US National Institute for Mental Health (NIMH) dislikes the DSM’s symptom-based approach, asserting that laboratory tests for biomarkers are the only rational way to diagnose mental illness. Arguably, the categorisation of mental illness based on symptoms can be useful, but it’s important to remember that those diagnostic categories are cultural constructions, not global certainties. For example, susto, or fright sickness, of Latin America, and what people in India call the dhat syndrome – in which men experience fatigue, anxiety and guilt – is a well-documented example of a psychological culture-bound syndrome.
Professor Christopher Dowrick put forward in a recent editorial in the British Journal of General Practice, that depression could be a western culture-bound syndrome, rather than a universal disorder. He noted that psychiatrists constantly shift the diagnostic goalposts, and this lack of consensus as to what constitutes depression supports his case. Professor Dowrick explained, ‘In western anglophone societies we have developed an ethic of happiness, in which aberrations … are assumed to indicate illness.’
But it’s not just depression, but pre-menstrual syndrome (PMS) that wellness experts have argued is a Western culture-bound syndrome. Thomas S Johnson claimed, in 1987, that PMS symptoms are an expression of ‘conflicting societal expectations’ on women, while a 2012 meta-analysis of published research failed to find evidence that negative mood correlates to the pre-menstrual phase of the menstrual cycle.
However, Dr Rachel Cooper, author of Classifying Madness, comments, ‘I think the distinction between “biological” and “social” causes can get tricky. Lots of human practices that are clearly culturally patterned – child-rearing practices, diet, and sleep patterns, for example – affect our biology. You could have cases where a “core” biological disturbance is expressed differently in different cultures. Some have suggested that this might be the case with western-style depression and Chinese neurasthenia.’