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A biocultural approach to psychiatric illnesses

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Abstract

Rationale

As a species, humans are vulnerable to numerous mental disorders, including depression and schizophrenia. This susceptibility may be due to the evolution of our large, complex brains, or perhaps because these illnesses counterintuitively confer some adaptive advantage. Additionally, cultural and biological factors may contribute to susceptibility and variation in mental illness experience and expression. Taking a holistic perspective could strengthen our understanding of these illnesses in diverse cultural contexts.

Objectives

This paper reviews some of these potential factors and contextualizes mental disorders within a biocultural framework.

Results

There is growing evidence that suggests cultural norms may influence inflammation, neurotransmitters, and neurobiology, as well as the illness experience. Specific examples include variation in schizophrenia delusions between countries, differences in links between inflammation and emotion between the United States and Japan, and differences in brain activity between Caucasian and Asian participants indicating that cultural values may moderate cognitive processes related to social cognition and interoception.

Conclusions

Research agendas that are grounded in an appreciation of biocultural diversity as it relates to psychiatric illness represent key areas for truly interdisciplinary research that can result in culturally sensitive treatments and highlight possible biological variation affecting medical treatment.

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Notes

  1. This is complicated by increased international migration. Additionally, within-group genetic variation is larger than variation between groups (e.g., Lewontin 1972), these ethnic/national categories only poorly map on to patterns of genetic diversity (Long and Kittles 2009), and self-identified ethnicity is often a poor indicator of genetic ancestry (e.g., Mersha and Abebe 2015).

  2. Cultural differences in psychiatric disorder epidemiology, etiology, etc. raise the question of the universality of emotional expression and interpretation in humans. Depression and schizophrenia, for instance, are diagnosed in part based on the presence of inappropriate emotional states. It is certainly reasonable to think that (in)appropriate emotional responses are shaped by culture, meaning that a pattern of behavior may be considered pathological in one cultural context but not another. A lengthy discussion of the universality of human emotions is beyond the scope of this paper, but data suggest that at least some facial and vocal expressions are uniformly recognized between cultures (e.g., anger, grief) but also that there may be emotional dialects, i.e., subtle differences in emotional expressions, that hinder identification in members of an out-group (for review see Scherer et al. 2011). Commendably, the DSM-V has addressed the role of cultural norms in the diagnosis of some psychiatric illnesses (Table 2 in Paniagua 2018).

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Acknowledgements

I thank David Samson for his kind and helpful comments, as well as the anonymous reviewers who have helped improve this manuscript.

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Shattuck, E.C. A biocultural approach to psychiatric illnesses. Psychopharmacology 236, 2923–2936 (2019). https://doi.org/10.1007/s00213-019-5178-7

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