Cultural adaptations of current psychiatric classifications: are they the solution?

Dhat syndrome: Evolution of concept, current understanding, and need of an integrated approach

Dhat syndrome has often been construed as a culture-bound sexual neurosis of the Indian subcontinent. Symptoms similar to that of Dhat syndrome has been described in other cultures across different time periods. The present paper looks at the evolution of the concept of Dhat syndrome in India. The review also takes an overview of the current understanding of this syndrome in terms of nosological status as a distinct entity and its "culture-bound" status. The narrative finally attempts to discuss the integrated approach for the treatment of this disorder.

[Psychopathology in the social context]

In his treatise "Allgemeine Psychopathologie"(1913) (general psychopathology), Karl Jaspers contrasted the avoidance of methodical one-sidedness, which today is described as being interdisciplinary, and the danger of making partial conceptions absolute. He argued in favor of the combined observation of the psychopathological phenomena of the "natural human being" to be analyzed and explained by scientific (and epidemiological) methods along with understanding the individual case study of the "cultural human being", which a person is as well, by using humanitarian hermeneutic methods. Because he discussed the social context only briefly, we will illustrate this in the following with specific examples: 1. social influences on the contents and forms of the appearance of psychopathological phenomena together with definitions that separate these pathological from abnormal psychic phenomena, 2. social conditions, i.e. imprinting of dispositions as risk factors and the social situation of psychopathological phenomena and 3. their social consequences. Taken together these are arguments for a biopsychosocial model, which, however, to date is seen as arbitrary in respect to causal explanations, which remains vague and which present no rules for weighting the relevance of individual determinants. However, the educational and didactic value of the model, to consider systematically the patient in its entirety, is undisputed and should encourage psychiatrists to investigate in depth the complex constellations of conditions of psychic disturbances on the microlevel.

A contribuição dos estudos transculturais dos países latino-americanos e caribenhos para a revisão da CID-10: resultados preliminares

OBJETIVO: Esta revisão visa identificar as evidências dos estudos de países da América Latina e do Caribe para a inclusão das síndromes transculturais na versão da Classificação Internacional de Doenças para sua 11ª Edição. MÉTODO: Os estudos foram identificados nas bases do Medline, LILACS e EMBASE, no período de 1992 a 2008, e classificados segundo o tipo de estudo, tipo de transtorno, país e número de publicações por ano. RESULTADOS: Foram selecionadas e classificadas 163 publicações: 33 no Medline, 90 no EMBASE e 40 no LILACS. A percentagem das síndromes transculturais ("culture bound-syndrome") correspondeu a 9% no Medline, 12% no EMBASE e 2,5% no LILACS. Dos 15 estudos sobre síndromes transculturais, dois eram sobre "nervios e ataque de nervios", dois sobre "susto", quatro sobre a relação entre crenças religiosas, "feitiçaria", transe e apresentação dos transtornos mentais, um sobre proposta de uma nova categoria diagnóstica, três artigos teóricos e três sobre psicopatoplastia dos transtornos mentais. CONCLUSÃO: A escassez de estudos sobre síndromes transculturais pode ter ocorrido pela dificuldade em rastrear os estudos por problema de indexação das publicações, falta de interesse em publicar tais estudos em periódicos indexados e a dificuldade de acesso às publicações. Dentre os estudos identificados, não há uma evidência clara que aponte quais modificações são necessárias nas classificações diagnósticas atuais.

Ethnopharmacological investigation of plants used to treat susto, a folk illness

Selected plants used to treat susto, a folk illness recognized by various groups of Latin America, were screened for anxiolytic and/or fear suppression activity in behavioral assays. We found that the plant used by most of the healers interviewed (Adiantum tetraphyllum Humb. & Bonpl. ex Willd.; Adiantaceae) suppressed certain components of anxiety and fear. To our knowledge, this is the first report on the biological activity of Adiantum tetraphyllum. This finding supports the contention that susto may represent what in the Western culture is defined as fear or anxiety, and hence may share the same psychological, biological or neural underpinnings. In light of the available literature, this represents the first experimental investigation of the biological activity of plants specifically in the perspective of their use in treating a culture-bound syndrome.

Generalized anxiety disorder: What are we missing?

One of the most prevalent anxiety conditions seen in primary care is generalized anxiety disorder (GAD). Numerous physical ailments frequently accompany the psychic symptoms of anxiety, which often drive patients to ask for help. In spite of the high incidence of GAD, only 30% of sufferers are diagnosed. Furthermore, very few patients are prescribed medication or referred to a psychiatrist. The key aim is to ensure the early detection and management of these patients. Developing physician education programs may improve the identification of GAD. The use of simple diagnostic tools would also aid the early detection of sufferers. Physicians require more long-term data, including that on the influence of ethnicity and genetics, to assist them to better understand and more effectively manage GAD. By achieving early diagnosis and treatment of GAD, physicians can ensure that a lesser burden is inflicted upon sufferers, thus improving their quality of life.

Beyond the 'new cross-cultural psychiatry': cultural biology, discursive psychology and the ironies of globalization

The 'new cross-cultural psychiatry' heralded by Kleinman in 1977 promised a revitalized tradition that gave due respect to cultural difference and did not export psychiatric theories that were themselves culture bound. In the ensuing years, the view of culture within anthropology has continued to change, along with our understanding of the relationship of biological processes to cultural diversity, and the global political economic contexts in which mental health care is delivered. This article considers the implications of these new notions of culture, biology and the context of practice for theory in cultural psychiatry. The future of cultural psychiatry lies in advancing a broad perspective that: (a) is inherently multidisciplinary (involving psychiatric epidemiology, medical anthropology and sociology, cognitive science and social psychology), breaking down the nature/culture dichotomy with an integrative view of culture as a core feature of human biology, while remaining alert to cultural constructions of biological theory; (b) attends to psychological processes but understands these as not exclusively located within the individual but as including discursive processes that are fundamentally social; and (c) critically examines the interaction of both local and global systems of knowledge and power. Globalization has brought with it many ironies for cultural psychiatry: Transnational migrations have resulted in cultural hybridization at the same time as ethnicity has become more salient; the call for evidence-based medicine has been used to limit the impact of cultural research; and cultural psychiatry itself has been co-opted by pharmaceutical companies to inform marketing campaigns to promote conventional treatments for new populations. Cultural psychiatry must address these ironies to develop the self-critical awareness and flexibility needed to deliver humane care in shifting contexts.