✍ Scribed by Morton Beiser
No coin nor oath required. For personal study only.
What is culture-bound about illness: the ideas people subscribe to about the way illnesses behave or the way in which signs and symptoms actually occur and/or cluster together? Confusion between these two levels of discourse creates arguments about nosology and culture. Dr. Prince and Tcheng-Laroche propose a solution; let us focus on describing constellations of signs and symptoms and use these descriptions as the bases for psychiatric nomenclature. The authors argue that the DSM-III, a syndrome-based classification of diseases, comes close to being a truly international system; With slight modifications, a place can be found within DSM-III for many so-called culture-bound syndromes (CBS), even such exotic specimens as taifin-kyofu-sho. For other syndromes, which will be found not to fit, and which conform to certain inclusion and exclusion rules advocated by the two authors, new categories --culture-bound syndromes --can be created.
One intent of the paper seems to be to make DSM-III even more comprehensive than it currently is and, in those instances where conditions will be found which do not fit the DSM-III, to set out clear guidelines by which they may be defined as culture-bound syndromes. For this reviewer, Prince and Tcheng-Laroche's provocative paper raises two questions: Can and will most conditions "fit" the DSM-III format? Is the approach to unclassifiable illnesses a useful one?
Prince and Tcheng-Laroche advance the premise that the closer one can come to achieving a nosology which cuts through the obscuring layers of cultural hermeneutics of illness to the bedrock of observable and recurring patternings of signs and symptoms, the greater the likelihood of scientific and clinical advance. Given our current scientific knowledge, this is a reasonable goal. However, despite Prince and Tcheng-Laroche's evident satisfaction with it, DSM-III is still far from being such a nomenclature.
To begin with, the constellations of criteria which make up DSM-III diagnoses are an amalgam of observation and inference. To the extent that inference enters into a system, culture will play a large role in determining how things are classified. The very notion of how and which symptoms and signs cluster together is, for the most part, not based on empirical Culture, Medicine and Psychiatry 11 (1987) 29--33.
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An important endeavor in the world psychiatric community is the development of an international classification of psychiatric disorders that will be more culturefree than either the current DSM-III or ICD-9. This classification should be clinically useful and relevant to psychiatric experience in al