© 2015 Elena Sergeevna MOLCHANOVA
2015 – №2 (10)
Key words: culture, psychopathology, homogenization of psychiatry, PTSD
Abstract: Diagnosing a mental disorder is not limited to reconciling the symptoms listed in modern classification systems with symptoms noted during a medical check-up by the psychiatrist. Universal algorithms, protocols and classifications are convenient and have undoubtedly positive consequences as they introduce a common thesaurus for all. However, psychiatric globalization erases details related the place of residence, historical time, social or ethnic characteristics. All these “little things” that are rated as “insignificant” can be crucial in the process of making a diagnostic decision. This article is devoted to the problem of homogenization of ideas about mental pathology; special attention is paid to disorders related to traumatic stress. The author introduces the reader to the multimodal approach to understanding and diagnosing mental disorders, which symptoms depend on the cultural context no less than on biological causes.
The article enlightens those problems that a relatively new field of study – cultural psychopathology deals with. Evidently, culture has a powerful influence on psychopathology, shaping spectrum of typical behavioral responses on physical and psychological stressors, coping strategies, self-representations, basic motivations, terminology, comprehending concepts of “normal” and “abnormal”, including concepts of health and illness. Culture also determines all the stages of scientific research from theoretical frameworks to communication between a researcher and a respondent. In spite of indisputable cultural influence on clinical presentation of symptoms, duration, and even prognosis of a mental disorder, the cultural dimensions of psychopathology have not been taking seriously up to nowadays.
The process of homogenizations of all mental health spheres erases cultural differences, such as belonging to a specific historical time, particular social and ethnic group, place of birth and place of living. It is important to mention, that cultural psychopathology is not opposite to universal approaches, and moreover, it enriches them by adding new knowledge, underlying significance of the cultural context in diagnosis and treatment processes.
Posttraumatic stress disorder is taken as an example of homogenization process. It demonstrates western-oriented approach to the diagnosis, emphasizes behavioral manifestations of disorders, which can distance a psychiatrist from the inner experiences of the patient. PTSD is presented as a convenient amalgam of mental disorders evoked by extreme trauma.
By listing numerous difficulties, connected with homogenization of mental health, this article underlines a high level of importance of integrated multidimensional approach to assessment and treatment a person within specific cultural context, but not an average individual separated from his/her cultural background, even such approach exceeds the limits of clinical standards.
Note:
* The article is also published in the paper edition:
Meditsinskaia antropologiia: kul’tura i zdorov’e. Sb. statei / otv. red. V.I. Kharitonova; In-t etnologii i antropologii im. N.N. Miklukho-Maklaia RAN; Assotsiatsiia meditsinskikh antropologov. – M.: IEA RAN, 2016. (Trudy po meditsinskoi antropologii). [Medical Anthropology: Culture and Health. Collection of articles / Ed. V.I. Kharitonova; Institute of Ethnology and Anthropology named after N.N. Miklouho-Maclay RAS; Association of Medical Anthropologists. – Moscow: IEA RAS, 2016. (Works on medical anthropology).]
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This article is available in full version in Russian