Commentary on 'Case Studies of Innovative Practice and Policy' Section
The chapters in this section present a number of case studies describing innovative mental health initiatives being conducted in a variety of different countries. Mental health is co-produced by a range of factors, some of which can be collectively captured by what is loosely defined as ‘culture’. Lewis-Fernandez, chair of the Culture Subgroup of the Gender and Culture Study Group of the American Psychiatric Association fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), describes culture as:
an interpretive framework for symptoms, signs, behaviors which are transmitted, revised, and recreated within families and society. They affect boundaries between normality and pathology, thresholds of tolerance, coping, and interpretations of need for help, and awareness of the impact of culture may reduce misdiagnosis. Culture may help determine support and resilience, by contrast, it may contribute to vulnerability and stigma. It helps shape the clinical encounter and affects help-seeking choices, adherence, course, recovery. (Lewis- Fernandez et al. 2014, p. 5)
On the other hand, there are also issues relating to the reification of culture as something which is untouchable and unquestionable. Certain cultures may hold particular views around what constitutes appropriate sexuality, gender
School of Psychology, The University of East London, London, UK © The Author(s) 2017
R.G. White et al. (eds.), The Palgrave Handbook of Sociocultural Perspectives on Global Mental Health, DOI 10.1057/978-1-137-39510-8_36
roles or age-appropriate behaviour, and these may be monitored in a range of ways which may be seen as antithetical to international human rights or social justice perspectives. For example, currently, 75 countries have legislation banning homosexuality and 10 have the death penalty for contravention of the legislation (Bearak & Cameron, 2016). If cultural beliefs and practices are unquestioningly accepted, this may create circumstances where two opposing views collide, those of a cultural position and those of human rights. How notions of acceptable behaviour or mental health are negotiated within low- and middle-income countries (LMICs) and high-income countries (HICs) are complex and, as this section illustrates, the bilateral sharing of ideas from both HICs and LMICs is important.
The way in which culture has been dealt with by diagnostic manuals such as the American Psychiatric Association’s DSM and the World Health Organization’s (WHO’s) International Classification of Disease (ICD) has been a contentious issue. For example, earlier versions of both diagnostic manuals were criticised heavily for not adequately considering issues of culture (Mezzich et al. 1999; Summerfield 2002). In DSM-IV (American Psychiatric Association 1994), cultural differences were largely dealt with through the addition of a separate appendix, which merely listed a number of culturally specific clinical presentations and appeared to lack any link with the main text. DSM-5 (the latest iteration of DSM) (American Psychiatric Association 2013) has taken more account of cultural differences and contains the DSM-5 Cultural Formulation Interview, introduced in DSM-IV. This is discussed in more detail by Thornton in his chapter in section one of this volume.