Transcript Are the DSM Disorders Universal Across Cultures?

Are the DSM Disorders
Universal Across
Cultures?
Karen Young
Psychology & Health Studies
University of Toronto Scarborough
Background
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Adapted from a literature review for a HLTD01 – Directed Readings Study
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Supervisor: Dr. Katie Kilroy-Marac
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“Katie Kilroy-Marac received her PhD in Anthropology from Columbia
University. Her research considers the social history of psychiatric thought,
the evolution and naturalization of psychiatric categories, and the spaces in
which local understandings of illness and suffering come into contact with
(Western) psychiatric models. ”

Inspiration for the content ANTC24 – Culture, Mental Illness, and Psychiatry
(another course taught by Dr. Katie Kilroy-Marac)
Acknowledgements of My Own
Background
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Middle to upper middle class
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Cis-gendered
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Able-bodied
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University educated
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Mental Health – recognition challenges pertaining to mental health during my
time in undergraduate
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Globalized ‘cultural’ background – I was born in Canada to parents of both
Chinese diaspora.
Introduction
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Given its nature as a “universal language” (Lurhrmann, 2000, p. 231), how
does it interact with other cultural belief systems?
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I argue that the process of interpreting aspects associated with the DSM
disorders:
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a) is adopted or dropped based on its incoherency or lack of coherency over time
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b) if adopted, the mechanisms underlying the interpretation help or harm the
mental health experiences of these societies;
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c) whose existence is vulnerable to other cultural forces.
Another Inspiration
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Inspired by Gananath Obeyesekere, Emeritus Professor of Anthropology
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“[t]o study work, one needs a case history approach contextualized in a specific
culture. This would enable us to identify the mechanisms involved in symbolic
transformation” (1986, p. 148).
We will look at the application of Post-Traumatic Stress Disorder (PTSD) in the
context in the 1970s and 1980s United States and in the 2000s Sri-Lanka (nonAmerican context)
Further Readings
All works were originally published in English between the years 1986-2012, by American
journalists, American anthropologists, and American and Canadian academics.
1.
Watters, Ethan. 2010. Crazy Like Us: The Globalization of the American Psyche. New
York: Free Press, pp. 9-63 (“The Rise of Anorexia in Hong Kong”)
2.
Watters, Ethan. 2010. Crazy Like Us: The Globalization of the American Psyche. New
York: Free Press, pp. 65-125 (“The Wave the Brought PTSD to Sri Lanka”)
3.
Obeyesekere, Gananath. 1986. "Depression, Buddhism, and the Work of Culture in Sri
Lanka.” In Culture and Depression: Studies in the Anthropology and Cross-Cultural
Psychiatry of Affect and Disorder. A. Kleinman and B.J. Good, eds. Berkeley:
University of California Press, pp. 134-152
4.
Young, A. (1997). The harmony of illusions: Inventing post-traumatic stress disorder.
Princeton University Press. pp. 89-117 (Chapter 3: The DSM-III Revolution)
5.
Young, A. (1997). The harmony of illusions: Inventing post-traumatic stress disorder.
Princeton University Press. pp. 145-175 (Chapter 5: The Technology of Diagnosis)
6.
Young, A. (1997). The harmony of illusions: Inventing post-traumatic stress disorder.
Princeton University Press. pp. 176-223 (Chapter 6: Everyday Life in a Psychiatric Unit)
Further Readings
1.
Watters, Ethan. 2010. Crazy Like Us: The Globalization of the American
Psyche. New York: Free Press, pp. 127-185 (“The Shifting Mask of
Schizophrenia in Zanzibar”)
2.
Good, B. J. (1997). Studying mental illness in context: Local, global, or
universal?. Ethos, 25(2), 230-248.
3.
Watters, Ethan. 2010. Crazy Like Us: The Globalization of the American
Psyche. New York: Free Press, pp. 187-248 (“The Mega-Marketing of
Depression in Japan”)
4.
Heine, S. J. (2012). Cultural psychology. New York: WW Norton. pp. 458-490
(“Chapter 8: Mental Health”)
5.
Luhrmann, T. M. (2000). Of two minds: The growing disorder in American
psychiatry. Alfred A. Knopf. pp. 203-238 (“Chapter 5: Where the Split Came
From”)
6.
Anderson-Fye, E. P. (2004). A “Coca-Cola” shape: Cultural change, body
image, and eating disorders in San Andres, Belize. Culture, Medicine and
Psychiatry, 28(4), 561-595.
History of Tension of Psychodynamics
and Psychiatric Science
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Both psychiatric science and psychodynamics are cultural belief systems
themselves
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Rise of psychodynamics: end of 19th century to just after WWII,
psychodynamics (Freud) offered an elaborate theory in addressing social
problems of the time
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Fall of psychodynamics: unverifiable: role of therapist was to interpret the
inner understanding of their patients
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Rise of psychiatric science and the birth of the DSM: Psychiatric science
(Spitzer) “addressed” the flaws of psychodynamics
Notes on Terminology
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“Psychiatric science” “v.s.” Psychotherapy  distinguish the ideologies in
recent/present-day context
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Diagnostic Statistical Manual (DSM)  DSM III, IV, V as psychiatric science
took a dominant ideological hold to the creation of these editions
DSM Disorders - PTSD
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Inducted into the DSM-III
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Ultimately created by the political interests at the time
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DSM-III definitions decontextualized the distinctive cases of PTSD resulting in
a simple theoretical design:
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Advocates for Vietnam War Veterans and movement later included more advocates
 creating a timeless and placeless presence (Watters, 2010, p. 115-116)
traumatic event must ultimately occur before the symptoms occurs.
PTSD as a diagnostic tool has a history of overlooking the experiences of the
patients it was supposed to serve, across place and time, both recently after
the Vietnam War at an American Veterans Administration psychiatric facility
in the 80s as well as more recently after the 2004 tsunami natural disaster in
Sri Lanka.
PTSD in the United States 1970s and
1980s
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A series of curious incidents at a Veterans Administration psychiatric facility in
the US, the National Center for the Treatment of PTSD, whereby wielders of
the adopted psychodynamic theory into practice took form in a way that
created an ideology-centric interaction between the cultural expectations
and the social experiences of the people who affected by it.
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Diagnosticians came together between 1986 and 1987, to determine the
diagnosis of Vietnam veterans and admissions as inpatients or outpatients,
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the process of admitting these men into the clinic involved interpreting for content
and structure into the psychodynamic narratives, at the same time, disregarding
the context of these four men (Young, 1997, pp. 173-174).
PTSD in the United States 1970s and
1980s
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Patients would learn how to socialize with the system’s beliefs (p. 214).
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Veterans Administration compensation rating board would offer more money for
negative clinical evaluations  diagnosed patients would want to increase their
impairment to obtain a higher compensation.
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Center was mandated by Congress law to conduct research related to the etiology,
symptomatology, and treatment of PTSD, meaning competition with other clinics
(p. 184).
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This competition means incentivizing the practice of the clinic to demonstrate positive
clinical evaluations.
PTSD in Sri Lanka 2000s
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After the 2004 tsunami hit Sri Lanka, it triggered the largest psychological
intervention ever (Watters, 2010, p. 70).
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Westerners overlooked key ways of Sri Lankans culturally coping with their
own suffering while they were so focused on the practicing their received
universalism of PTSD (Watters, 2010, p. 77).
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This mechanism of blinding oneself to the actual realities and understanding of the
realities could eventually lead to the ironic outcome of harming the society that
many came so far to serve.
PTSD in Sri Lanka 2000s
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Acting on the false notion that PTSD is not universal, Sri Lankans were more
likely to experience physical as opposed to psychological pains after horrible
events (p. 91). In addition, the diagnosis of PTSD failed to consider the
cultural context of shared cultural suffering in a society sensitive to outbreaks
of violence (pp. 103-104).
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Villagers in a poor Sri Lankan village lived with a complex communication system in
which any sensing of moment of terror coming from violence could trigger a fearrelated illness of a “terrified heart” (Waters, 2010, p. 110). Speaking directly
about it was considered pathological, so indirect speech was used to manage the
triggering of a “terrified heart”.
Conclusion
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The way Spitzer ultimately created them is this: a constellation of symptoms
that were to have to meaning in the first place. By deliberately eliminating
the feature of interpretation, Spitzer ultimately and ironically left the DSM
disorders to the interpretation of many
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“Affects [that] exist more or less in a free-floating manner, awaiting a different
symbolic formulation” (Obeyesekere, 1986, p. 148)
Discussion Questions
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How do the DSM disorders affect the lives of those today who are diagnosed?
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Are the DSM disorders universal?