Psychiatric Diagnosis and Classification - ResearchGate

EVOLUTIONARY THEORY, CULTURE AND PSYCHIATRIC DIAGNOSIS 131
Incorporating Evolutionary Theory in a Psychiatric Nosology
Although the HD formulation may not serve as the ultimate ``scientific''
criterion for the definition of a psychiatric disorder, this by no means
implies tenets of evolutionary theory should not be represented in a system
of psychiatric diagnosis. The history of psychiatry and empirical research
underscore the importance that disorders e.g. Axis I of DSM-IV) will likely
continue to play in future systems of diagnosis. Because of the high prevalence
of comorbidity and the difficulty of establishing clear boundaries
between disorders [61±63], it seems prudent to hold that individuals in
need of psychiatric care embody a clinical condition made up of one or
several disorders. Moreover, the condition more than the disorders is what
limits an individual's capacity and ability to function [64].
This means that the basic functional capacities to execute behavior as
authorized by evolutionary theory constitute important ``facts'' about a
psychiatric condition of an individual. McGuire and Troisi [19] have provided
a comprehensive listing of these including their behavior components.
Such functional capacities constitute human universals that could be
incorporated by means of separate axes or numerical coding schemes in a
system of diagnosis. Many of the directives of evolutionary psychiatrists are
highly consistent with basic psychosocial, behavioral, and psychotherapeutic
approaches in psychiatry.
Incorporating Culture Theory in a Psychiatric Nosology
At least for the foreseeable future, settings of evaluation, especially in large
Western cities, will involve individuals from non-Western, less developed
societies. Proficiency in the language of the host country is likely to be low.
The social backgrounds and cultural orientations of potential patients are
likely to: a) contrast with that of the host country and especially with basic
conceptions about self, experience, and behavior that are integral to scientific
medicine and psychiatry; b) emphasize more somatic as compared to psychological
factors in health and disease; c) manifest a more social centered as
compared to a person centered orientation regarding the meaning, purpose,
and calibration of behavior; and d) include a more spiritual emphasis on
experience, purpose, obligation, and personal accounting. The concept of
what is private and hence closed to inquiry will differ as well. Ease of selfdisclosure
and openness to questions regarding social, interpersonal, and
spiritual matters are likely to differ from what is regarded as relevant to the
ordinary, typical psychiatric history. The lay conception of a ``mental illness''
will not coincide with that of psychiatry, and the way personal symptoms
and impairments are explained i.e. explanatory models) will likewise differ