Psychiatric investigations among American Indians and Alaska natives: a critical review

This review of psychiatric investigations among Native Americans opens with a discussion of the dominant theoretical perspectives in psychiatric anthropology in order to provide an analytic framework with which to assess the substantive findings of researchers in the field. Studies of culture-specific disorders, service utilization and patient population studies, psychiatric epidemiological studies, and studies designed to test the validity of certain diagnostic instruments are scrutinized for evidence of the nature of the role of indigenous cultures in the manifestations of psychiatric disorders among these populations. The review reveals that a universalist theoretical perspective, which tends to obscure the role of local interpretations in the phenomenology of psychiatric illness, dominates this field of inquiry. Nonetheless, evidence has accumulated which indicates the importance of native understandings for a more reliable and valid explanation of the nature of mental disorder among these peoples. The inadequacies of our current knowledge are examined and suggestions for directions in future work are presented in the concluding section. Recommendations include the direct investigation of the local meanings of the signs, symptoms, and syndromes of Western psychiatry; the concentrated search for potentially unique and powerful local signs of distress; and the study of the culturally-constituted social processes of illness.