Psychiatric Diagnosis and Classification - ResearchGate

34 PSYCHIATRIC DIAGNOSIS AND CLASSIFICATION
circuitryinvolved in complex emotional and cognitive functions will accelerate
the development of testable hypotheses about the exact pathophysiological
bases of mental disorders.
Genetic sciences emphasize the interaction between the genome and the
environment and hopefullywill lead to a better understanding of the
plasticityof the human brain and how it malfunctions in mental disorders.
This approach is different from seeking a molecular pathologyfor every
mental sign, and the progress of gene expression through central nervous
system function to emotional and cognitive constructs will always describe
multilinear processes.
Progress in the neural sciences is alreadyblurring the boundaries of the
brain and mind, yet such a mind±body dualism as expressed in the organic
vs. non-organic distinction in the ICD but not in DSM) does have a utility. It
directs the clinician to payspecial attention to an underlying ``physical''
state as the cause of the ``mental'' disturbance. However, the term ``organic''
implies an outmoded functional vs. structural and mind vs. bodydualism.
Similarly, at the other end of the spectrum, cultural relativism can undermine
efforts towards the meaningful diagnosis of mental disorders. The
view that stigma and labelling can wronglydefine a person as ill implies
that mental illnesses are ``myths'' created by society. This has resulted in a
devaluation of insights that are inherent in a cultural perspective. A similar
danger of further dismissing the role of cultural factors in the causation,
maintenance and outcome of mental disorders exists when culture is seen as
antithetical to neurobiology.
International Use: Need for Universalism and Diversity
As an international classification of diseases, the ICD must contain a culturallyneutral
list of all possible disease entities. The frequencies with which
these conditions occur in different settings cannot be a principle used to
include or exclude conditions. The need to find a ``common language'' of
mental disorders must be balanced with the need to keep local sensitivities
in mind, and to allow users of the classification to find the appropriate
conceptual equivalents and to identifyvariations in their culture.
Culture
Although some cultural elements have been included in the ICD and DSM,
much remains to be done. There is a need to move beyond ``culture-bound
syndromes'', the inclusion of which perhaps does little more than pay lip
service to the recognition of the role that culture plays in the manifestation