Chapter 1: Understanding Cultural Disorders

Cultural disorders have significant implications not only for psychiatrists engaged in case identification and diagnosis but also for the DSM working groups that create the diagnostic criteria for various mental health conditions. Dr. Bruce Long, in a recent philosophical paper, supports the assertions made by Carol Gould regarding the exclusion of histrionic personality disorder (HPD) from the current and future editions of the Diagnostic and Statistical Manual for Mental Disorders (DSM5-TR):

Why the histrionic personality disorder should not be in the DSM: A new taxonomic and moral…

Carol Steinberg Gould, Why the histrionic personality disorder should not be in the DSM: A new taxonomic and moral…

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Gould's foundational argument posits that HPD is not merely an individual disorder (predominantly diagnosed in women) but rather a reflection of cultural issues. Examples such as the endorsement of practices like turning young boys into eunuchs to maintain their singing voices, female genital mutilation, and the use of a fictional deity to justify such actions illustrate the notion of cultural disorders.

If a therapist subscribes to the belief that a deity views women as inferior, then this may be classified as a cultural disorder according to scientific criteria. Long argues in his research that therapists who entertain such beliefs are not only affected by cultural disorders but may also be experiencing a genuine mental health issue.

MINOR UPDATE TO RESEARCH PROGRAM AND PAPER “A CALL FOR THE INCLUSION OF RELIGIOUS SCHIZOPHRENIC…

Dr. Bruce Long advocates for the formal recognition of religious schizophrenia as a diagnosable condition in the DSM.

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Individuals who have been diagnosed with a personality disorder should consider seeking a second opinion from an independent clinical source, and it is essential to examine the scientific validity of the diagnosis itself. While it does not imply that such diagnoses are inherently incorrect, there is a considerable likelihood of inaccuracy, which is often underestimated. Many errors stem not only from malpractice and incompetence but also from ongoing issues related to the categorization of mental disorders and the development of dimensional diagnostic criteria.

While I do not align myself with the anti-psychiatry movement (I simply oppose poor psychiatry and malpractice), there are compelling reasons recognized by psychiatrists, psychologists, and philosophers in the field of psychology and psychiatry to approach psychiatric diagnoses with skepticism.

The first of these reasons is the reproducibility crisis, which gained recognition around 2010. This crisis pertains to the ability of independent researchers to replicate a controlled experiment or study following the guidelines established by the original designers. It was revealed that approximately 70% of psychological studies were not replicable, a situation that is both alarming and detrimental.

A second reason for caution regarding psychiatric diagnoses is that the reproducibility crisis coincided with the work aimed at establishing the diagnostic criteria for personality disorders in the DSM5. Consequently, it is likely that this crisis influenced the inputs and outputs from the working groups engaged in this process.

The Conceptual Development of DSM-V

Over the past 30 years, there has been a continuous testing of multiple hypotheses that are inherent in the Diagnostic…

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Although the replication crisis had a lesser impact on the factor analysis employed to generate related psychometric tests for diagnosis, it remains relevant. Factor analysis is generally more resilient due to its foundation in rigorous statistical modeling of conceptual schemas derived from lexical analysis. Yet, lexical analysis involves using dictionaries to identify all concepts associated with a psychological symptom or property. Therefore, if cultural disorders and flawed narratives influence the foundational concepts, even factor analysis can become epistemically compromised and diagnostically flawed.

It is reasonable to assume that the dictionary itself is susceptible to distorted narratives that underpin culturally disordered concepts associated with specific terms.

A third reason for exercising caution regarding psychiatric diagnoses is that both therapists utilizing psychometric instruments developed through factor analysis and the researchers responsible for creating DSM diagnostic criteria are vulnerable to cultural influences. These influences often manifest as cultural narratives and societal values.

Psychotherapists, being human, are susceptible to what is termed countertransference. In clinical psychology, transference occurs when a patient projects emotional responses onto the therapist that are inappropriate, often confusing the therapist with another significant figure in their life. This may involve viewing the therapist as a parent or developing romantic feelings toward them. Countertransference, conversely, occurs when the therapist has inappropriate emotional reactions to the patient:

Such countertransference is undoubtedly influenced by the therapist's personal values and beliefs, which are in turn shaped by the cultural narratives prevalent in their environment. Gould, in her argument for the exclusion of HPD from the DSM, highlights that the underlying issue of cultural disordered-ness is rooted in the misogynistic notion of hysteria:

Long supports Gould's position and further extends the analysis by proposing a criteria system to identify cultural disorders while examining the shortcomings of existing psychometric tests for HPD. Although Long is technically an anti-realist regarding HPD, he suggests two potential scenarios for a patient misdiagnosed with HPD. The patient may not have any personality disorder at all, leading to a misdiagnosis influenced by the therapist's cultural disorder and the subsequent misapplication of diagnostic criteria. Alternatively, the patient may have comorbid personality disorders, but not HPD itself; they may be suffering from narcissistic personality disorder and borderline personality disorder.

The history of the DSM is marked by numerous revisions. Homosexuality was once classified as a disorder, while multiple personality disorder has since been removed from the list. It is plausible that HPD will also be excluded in the next DSM edition, provided that distorted cultural narratives do not overshadow robust biopsychosocial evidence in developing diagnostic criteria.

Chapter 2: The Cultural Context of Psychiatric Diagnosis

This video discusses the intersection of culture and the DSM5, exploring how cultural factors influence diagnostic practices and the implications for mental health professionals.

This video examines Western culture-bound syndromes, shedding light on how cultural narratives shape our understanding of mental health and disorders.

References

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