Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
The wide variations of child development across cultures are reminders of the dynamic interaction of biological parameters with the diversity of human conditions.
The basic premise of the universalist perspective on psychiatric classification is that psychiatric disorders and syndromes are universal and have core symptoms that cluster into universal syndromal patterns. The relativistic perspective contends that culture shapes the individual’s development and his/her biological and psychological unfolding to a substantial degree, hence there is a need to integrate culture within the diagnostic classificatory system. At present, the literature addressing the universality or the cultural relativity of diagnosis in child psychiatry is sparse.
Most extant studies on cultural dimensions of child psychiatric diagnoses have focused on comparing prevalence rates of childhood onset diagnoses across groups and nations and have suggested that common childhood-onset diagnostic categories may be found universally. However, these studies emphasize reliability rather than validity, which is linked to the meaning of symptom patterns in a given social system.
The recognition of symptoms and the labeling of distress as being deviant or pathological depend on the norms of behavior accepted in a particular culture. Societies may differ with respect to the existing explanatory models which families put forward to explain illnesses. In addition, literature suggests cultural variation in clinicians’ definition of and attitudes towards child behaviours, e.g. hyperactivity. Consequently, the categorization as ‘pathological’ may vary depending on the perception of the clinician even if uniform criteria are used across cultures. Few investigators have also described syndromes that exist in one culture that were not found in other cultures. For example, a verbally internalizing syndrome and an immature syndrome among boys, and a covert delinquency syndrome and a habit problem syndrome among girls were reported among Thai youth but not in US youth. Similarly, substantial proportions of children from the community and those receiving psychiatric services in clinics in Peurto Rico were reported as having experienced an ‘ataque de nervios.’ These findings highlight the need to address cultural validity issues regarding child psychiatric disorders in specific socio-cultural contexts in order to avoid the category fallacy; which is the projection of a diagnostic category in another culture where this category lacks coherence.
While some disorders that are mostly based on neural pathology are likely to be universal; other more common disorders may be substantially shaped by social context, cultural norms and developmental stage. Much empirical work is needed to establish the validity of diagnostic categories across cultures.