Mental Disorders

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Mental Disorders

Mental Disorders Alex Cohen

BACKGROUND The Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (or DSM-IV) defines mental disorder as a “clinically significant … syndrome or pattern” in which an individual exhibits behavioral or psychological patterns that are associated with “distress, disability, or increased risk of pain or death” (American Psychiatric Association, 1994). However, there are several problems with this definition. First, it covers a vast range of conditions. One might reasonably ask whether it is valid for a single definition to encompass the entire spectrum of conditions: from the relatively rare, severe and chronic psychoses to the relatively common, often comparatively mild and intermittent mood disorders. Even if it is valid to speak of mental disorders in such an inclusive way, more precise focusing may be obligatory when formulating and testing hypotheses about the effect of sociocultural environments on human mental well-being. For example, Vikram Patel’s (1998) research in Zimbabwe focuses on the relationship of culture to the manifestation, course, and outcome of depression and anxiety, while Ezra Susser and his colleagues focus on brief psychotic disorders in India (Susser, Varma, Malhotra, Conover, & Amador, 1995; Susser & Wanderling, 1994). Second, the authors of DSM-IV point out that the use of the term “mental” implies a clear differentiation between “mental” and “physical” disorder, a distinction that does not, in fact, exist. For example, tropical diseases such as malaria and sleeping sickness may produce symptoms that mimic those of the psychoses and depression (Weiss, Cohen, & Eisenberg, 2000), and non-specific fevers have been implicated in the etiology of acute brief psychosis in Northern India (Collins et al., 1999). At the same time, physical disorders such as myocardial infarction may be precipitated by emotional states of fear or anger (Kendell, 2001). Low-back pain often occurs in the absence of a distinct physical disorder (Kleinman, 1988). Finally, epidemiological research in 10 countries found that loss of energy, a symptom that is clearly associated with a host of

physical disorders, was a core symptom among most people suffering from depression (Weissman et al., 1996). Third, the diagnostic categories of the DSM-IV were derived from evidence gathered almost exclusively from North American and European populations. If the discipline of anthropology has demonstrated anything, it is that the diversity of human behavior extends far beyond what can be observed within one, albeit broad, cultural group. Applying those categories to people in non-Western societies may result in what Arthur Kleinman has termed a category fallacy which he defines as: “The reification of one culture’s diagnostic categories and their projection onto patients in another culture, where those categories lack coherence and their validity has not been established” (Kleinman, 1988). Imagine a South Asian psychiatric epidemiologist conducting a study of semen loss synd