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538 Chapter
15
Psychological Disorders
In most people’s estimation, a person who hears voices of the
recently deceased is probably a victim of a psychological
disturbance. Yet some Plains Indians routinely hear the voices
of the dead calling to them from the afterlife.
This is only one example of the role of culture in labeling
behavior as “abnormal.” In fact, among all the major adult
disorders included in the DSM categorization, only four are found
across all cultures of the world: schizophrenia, bipolar disorder, major depression, and
anxiety disorders. The rest are prevalent primarily in North America and Western Europe
(Kleinman, 1996; Cohen, Slomkowski, & Robins, 1999; López & Guarnaccia, 2000).
For instance, take anorexia nervosa, the disorder in which people develop inaccurate
views of their body appearance, become obsessed with their weight, and refuse to eat,
sometimes starving to death in the process. This disorder typically occurs only in
cultures that hold the societal standard that slender female bodies are the most
desirable. In most of the world, where such a standard does not exist, anorexia nervosa
is rare. Until recently, there was little anorexia nervosa in Asia with some exceptions,
such as the upper and upper-middle classes of Japan and Hong Kong, where Western
infl uence is greatest (Watters, 2010).
Similarly, dissociative identity (multiple personality) disorder makes sense as a
problem only in societies in which a sense of self is fairly concrete. In India, the self is
based more on external factors that are relatively independent of the person. There,
when an individual displays symptoms of what people in a Western society would
call dissociative identity disorder, Indians assume that that person is possessed either
by demons (which they view as a malady) or by gods (which does not require
treatment).
Furthermore, even though disorders such as schizophrenia are found throughout
the world, cultural factors infl uence the specifi c symptoms of the disorder. Hence,
catatonic schizophrenia in which unmoving patients appear to be frozen in the same
position (sometimes for days), is rare in North America and Western Europe. In
contrast, in India, 80% of those with schizophrenia are catatonic.
Other cultures have disorders that do not appear in the West. For example, in
Malaysia, a behavior called amok is characterized by a wild outburst in which a usually
quiet and withdrawn person kills or severely injures another. Koro is a condition found
in Southeast Asian males who develop an intense panic that the penis is about to
withdraw into the abdomen. Some West African men develop a disorder when they
fi rst attend college that they call “brain fag”; it includes feelings of heaviness or heat in
the head as well as depression and anxiety. Finally, ataque de nervios is a disorder found
most often among Latinos from the Caribbean. It is characterized by trembling, crying,
uncontrollable screams, and incidents of verbal or physical aggression (Cohen,
Slomkowski, & Robins, 1999; López & Guarnaccia, 2000; Adams, 2007).
Explanations for psychological disorders also differ among cultures. For example,
in China, psychological disorders are commonly viewed as a weakness of the heart, a
concept that derives from thousands of years of traditional Chinese medicine. Many
terms used to describe emotions and symptoms of psychological disorders make direct
reference to the heart—but the association isn’t simply a metaphorical one. Chinese
people are more likely than people in Western cultures to express their emotional
anguish in terms of physical symptoms such as heart pain, “heart panic,” or “heart
vexed.” They may also see their emotional pain as merely a side effect of some
underlying physical cause or even focus more on the effects that their symptoms are
having on their relationships with friends and family members (Miller, 2006a; Lee,
Kleinman, & Kleinman, 2007; Watters, 2010).
In sum, we should not assume that the DSM provides the fi nal word on psychological
disorders. The disorders it includes are very much a creation and function of Western
cultures at a particular moment in time, and its categories should not be seen as
universally applicable (Tseng, 2003).
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