Yet one line of questioning in Loranger's work revealed that avoidant and borderline personality disorders were not found in patient groups from India and Kenya, respectively, even though these are two of the most common syndromes worldwide. The reason is not clear, but it is possible those from these cultures were loath to admit to symptoms, choosing instead to answer the related questions in what they thought was a socially acceptable way. This tendency could explain why a study by psychiatrist Wilson M. Compton of the National Institute on Drug Abuse showed a lower occurrence of antisocial personality disorders among Taiwanese patients than among Western ones. Compton found that politeness and passivity are highly regarded in the Far East and that the Taiwanese would rather not mention contrary impulses.
The multitude of differences among cultures clearly shows that mental health professionals are ill advised to apply their classifications of personality disorders to people from other cultures. Chinese doctors have indeed developed their own classification system, and it does not include avoidant or dependent personality disorders. Should conditions such as these, then, be considered normal just because they are prevalent in a society? That could very well be the case. Norms define which types of behavior are acceptable, so if a certain trait is common in a society, then perhaps there is nothing "wrong" with it, regardless of how it might be perceived elsewhere.
According to several studies comparing cultures, personality disorders occur more frequently in industrial countries than in less developed ones, where closer social connections tend to dominate. In large families or village communities, roles are clearly defined and evolve very slowly, if at all. Like a cocoon, the community ensures that no individual experiences isolation or feelings of uselessness. In contrast, life in the modern, developed West is hectic and uncertain. Perhaps personality disorders are one price we pay for individual freedom. A study by Joel Paris of McGill University supports this notion; he found that impulsive and emotionally unstable people--who are more prone to borderline disorders--exhibit clinical symptoms less often in more close-knit cultures.
As globalization steadily spreads, adequate diagnosis of patients from foreign cultures will become a more pressing issue. Therefore, psychologists and psychiatrists will have to become more cosmopolitan in their education; they should possess at least a rudimentary understanding of a patient's culture and language or call on interpreters in their consultations. For example, a Turkish woman new to the U.S. who is suffering from depression would be more likely to complain of pain in various parts of her body rather than expressing feelings of sadness. This tendency toward so-called somatization is common in the Turkish culture yet could lead to a false diagnosis in Boston or Rio de Janeiro.
An understanding of cultural differences is important not only in the diagnosis of mental disorders but also in their treatment. Western-oriented psychotherapy is based on the idea that patients can evolve and are free to determine their own behavior. People from traditional, often highly religious societies are not served as well by such approaches. Their mental well-being stems from fulfilling the expectations of family and community. The goals of therapy for such people must be adjusted to meet their cultural needs.
The question of whether a common multicultural denominator of personality disorders can be expressed remains unanswered. Until that day comes, diagnosis will for the most part remain open to cultural interpretation.
This article was originally published with the title Abnormal as Norm.