Certain men in Malaysia are driven by a fear that their genitals could retract up into their bodies. They even believe that the perceived condition, called koro, can be deadly. To prevent it, the men apply weights to their penises or take other extreme measures. The fear, and the uncomfortable antidote, is not common, yet it is accepted in this long-standing culture. But in a Western country, an adult male who acted on such a belief would certainly be labeled as emotionally disturbed.

This contradictory assessment and many others that arise between distant cultures put in sharp relief a strongly influential yet rarely discussed fact of psychology: cultural norms and values determine which behaviors are socially acceptable. In setting these standards, each society determines which mind-sets and actions may constitute a psychological disorder. And societies do not necessarily agree.

Cult of Thinness
Ethnologists have described a wide variety of culturally dependent syndromes, many of which can be categorized as anxiety or compulsive disorders. Whereas koro seems psychotic to Westerners, Malaysians would most likely find very strange the American "cult of thinness" that seems to underlie a personality disorder that prompts women to deprive themselves of food.

Some basic behavioral symptoms could be considered central to any kind of personality disorder, regardless of culture: Does an individual exhibit self-destructive behavior? Are symptoms intense and long-lasting? The real signature of a personality disorder, however, is a steady, long-held belief that makes it difficult for an individual to maintain his or her emotions, thoughts or actions at a socially acceptable level.

But what constitutes "socially acceptable"? In some Central and South American native tribes, adolescents cut their arms and wrists with sharp blades--an ancient initiation rite that leaves scars that mark them as members of the adult community. Though perfectly normal along the Amazon River, "cutting" in the U.S. has been established as a "personality disorder"--a pattern of emotional instability in relationships, self-image and mood that is marked by impulsiveness. Less exotic, local peculiarities can complicate the assessment of personality disorders, too. Taken out of their cultural contexts, the narcissism of the "Latin lover," the fanatical work hours of the Japanese businessman, and the screaming hysteria of British pop music fans at a live concert could all be taken as signs of trouble.

Researchers around the world have at times attempted to classify disorders and criteria to determine their diagnosis. Two resulting compendiums are now widely consulted: the International Classification of Diseases and Related Health Problems, published by the World Health Organization, now in its 10th edition, and the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, its most recent revised fourth edition released in 2000. The ICD-10 and DSM-IV-TR are far-reaching, yet even they do not satisfactorily take into account the diversity of the world's societies.

A few specialists known as cultural relativists are trying to fill the void by expanding the relatively new field of "transcultural psychiatry." Their efforts to organize the multiculturalism of mental illness will have to overcome the prevailing universalist perspective of traditional psychology: a patient's culture does not play a major role in the development of psychological disorders. In this view, fundamental illnesses are the same the world over and vary only in how frequently they occur in a given culture.

By publishing its huge reference volume, the World Health Organization seems to share this assumption. Experts such as Cornell University psychiatrist Armand W. Loranger, who have tested the DSM-IV-TR and ICD-10 criteria by interviewing patients from varied international backgrounds, have also concluded that cultural traits hardly play a role.

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