When 'disorder' doesn't translate: DSM categories, lived illness and social sickness across cultures

Diagnostic classifications (DSM, ICD and other system frameworks) make distress legible for clinical and institutional action. That is their strength. Yet classification is not a mirror of lived suffering: it necessarily prioritises operationalisable criteria over the cultural, relational and moral meanings through which people experience distress and decide whether help is needed. Building on Kleinman's distinction between illness (lived experience), disease/disorder (practitioner/system categories) and sickness (social recognition and response), this paper argues that cross-cultural failures in mental healthcare often reflect 'layer misalignment': disorder labels, illness meanings and sickness recognition diverge. Using taijin kyofusho, in which concerns about offending others can be mistranslated into standard self-focused social anxiety, as an illustrative case, this paper outlines a practical approach to reduce miscommunication: eliciting explanatory models, translating idioms into meanings, three-layer formulation, alignment checks and culturally safer service design.