Is it possible to create international definitions of psychological disorders? Most researchers have noted distinct differences in the brains of people with depression such as smaller hippocamps and we know that antidepressants work because they target receptors in the brain (such as serotonin receptors). These facts point to a biological basis for depression and if we follow this logic than depression should be the same across cultures…right? Can we then say that the symptoms of depression are universal? Are its treatments universal? A doctor can go anywhere in the world to give someone stitches and it will do the trick—there is no difference in a deep cut from country to country. This is not true for other medical issues. It appears that when it comes to psychological disorders, things get more complicated because cultural beliefs are embedded in mental illnesses.
The western world stresses the idea of treating cross-culturally, and of treating the ‘whole’ person. Learning this is a part of the training that doctors receive in medical school. Despite this training, I think that treating in such a way is easier said than done. I would guess that many scientists have trouble with this notion— for many of them a disease is a disease and that is that. After all, there is science to back it up. Well the science doesn’t always lead to the best and most effective treatments. The book The Spirit Catches You and You Fall Down by Anne Fadiman is an amazing work of non-fiction that describes how diagnostic misunderstandings between two cultures resulted in tragedy. The book is the story of the treatment of a Hmong child living in America, named Lia Lee, who was having seizures and was diagnosed with epilepsy. Her parents believed that her seizures were due to spirits that had overtaken her.
Although Shaman were typically used to help with the symptoms, Lia’s parent’s also looked towards western medicine to help them with their child and they brought her to the hospital every time she had an episode (which became increasingly frequent and she had more than 100 in her first few years of life). Unfortunately, the doctors did not communicate well with the family and did not understand the family’s cultural beliefs. The doctors had no conception that the parents believed spirits were involved and Lia’s parents did not understand why the doctors were recommending particular treatments with terrible side effects. Of course, both the parents and the doctors had Lia’s best interests in mind but this was not enough. Lia was left with irreversible and devastating brain damage.
The point of bringing this story up is to say that looking at disorders and diseases as embedded in cultures is essential, especially for treatment. I think that too often we deemphasize the importance of culture when we are dealing with science, but this is flawed; science cannot be completely separated from culture. Almost any disease, mental or not, varies across cultures. I strongly believe that psychology undergraduates would benefit from taking cross-cultural psychology classes, which could shed a whole new light on the field of psychology and on the power of culture.
So back to my first question: Is it possible to create international definitions of psychological disorders? Well if you haven’t guessed it by now, my answer would be no.