Mental Illness in a Multicultural Context

Abstract

How does culture affect the expression and prevalence of mental illness? This question reflects a critical tension in scientific investigations of mental health and illness that is revealed in the history of the development of the Diagnostic and Statistical Manual of Mental Disorders (DSM). The DSM provides a description of different "accepted" mental disorders and the clinical criteria for assessing each. Since the American Psychiatric Asso-ciation (APA) first published the DSM in 1952, it has become widely used by clinicians, psychiatric researchers, and social scientists for different purposes. As a foundation, DSM assumes that mental disorders are discrete biomedical entities that are explained by bio-medical processes. It is often implicitly assumed that psychiatric symptoms or syndromes are universally distributed and uniformly manifested. This assumption is unwarranted, be-cause groups vary in how they define such constructs as "distress," "normality," and "ab-normality." These variations affect definitions of mental health and mental illness, expres-sions of psychopathology, and coping mechanisms (White & Marsella, 1982). The changes from DSM-I to the latest version, DSM-IV, mirror some of the social and institutional changes that have taken place in the United States over this 45 year period