Culture, context and experience in psychiatric diagnosis

The semiotic theory underlying psychiatric diagnosis views symptoms as more or less direct consequences of psychopathological processes. However, cognitive social psychology and clinical ethnography make it clear that symptom experience is embedded in culturally based systems of meaning and discursive practices. Physiological perturbations are organized, experienced and expressed in terms of a nested series of cognitive schemas involving knowledge about symptoms, illnesses or other models of affliction and broader sociomoral notions of self and personhood. Individuals have many competing schemas at their disposal. The relative prominence or weight given to a specific model is determined by the social context and purposes for which the person is reflecting on, recollecting or recounting their experience. Accounts of symptoms and illness experience are therefore highly dependent on the social context of narration. Psychiatric nosology and the process of clinical assessment must consider the ways in which psychopathology is shaped by social and cultural contexts including those of the family, workplace, and health care system as well as global professional, economic and political interests.