International systems of diagnosis in psychiatry

Abstract

International standardization of diagnosis is the culmination of developments set in motion in Europe during the first half of the 19th century. Its ultimate rationale has been the science of descriptive psychopathology. The enterprise implies that a common way of defining, describing, identifying, naming, and classifying such disorders is possible and that a common system of psychiatric diagnosis constitutes a first step toward dealing with them. Its natural science approach implies that social and cultural factors are extraneous. Yet, as discussed, the enterprise is based upon unique historical and cultural responses to human behavioral individuality. Cultural aspects of psychiatric phenomena create tensions in the application of the internationalist enterprise: Although in theory applicable to all people regardless of populational/genetic, national, or cultural background, it is used by clinicians of highly specific cultural origin and in settings characterized by distinctive cultural traditions about sickness, healing, nonsickness or health, and social behavior. Tensions created by the international enterprise are discussed and illustrated by drawing attention to how cultural factors impact on its basic assumptions and by a selective review of literature.