Think cultural

The recurrence of biomedical triumphalism in psychiatry - a pattern which seems to obtain every 30 years or so - leaves little space for the social and cultural underpinnings of psychological distress and illness. Although short cultural sections can now be found appended to the American Psychiatric Association's revised Diagnostic and Statistical Manual, anthropological and historical critiques of psychiatric theory and practice are now generally excluded from the mainstream psychiatric journals in favour of genetics and radiological data. They are generally presented in new, more specialised journals such as Transcultural Psychiatry (Canada), Culture, Medicine and Psychiatry (United States) and Anthropology and Medicine (United Kingdom). And these have a closer relationship to social anthropology than to social psychiatry.

The marketing of the DSM worldwide leaves local mental health workers desperately trying to fit local illness experience into the North American categories with, so far, little public complaint. It is in the US itself that objections have been raised that these categories are historically and socially contingent; and it is those workers who are themselves members of ethnic minority groups who agree that cultural difference is significant.

Cultural Diversity and Mental Health is a new journal that articulates these views under an optimistic framework of gentle "identity" politics rather than critical theory - "diversity", not "difference". The social anthropologist will find problems here in the generally uncritical acceptance of biomedical categories. The papers here are concerned with how "culture" (in a rather hypostasised sense) affects or contributes to what are still universal categories, and how Western psychologists's rating scales can produce false results with minority groups. All the contributors and most of the editors are North American (often members of minority groups themselves), and an autobiographical feature in each issue offers an account of how being a member of a minority in the US influences one's training and experiences in mental health. This is welcome but can be a little gushy.

The ideas of "mental health" offered are fairly vague but generous, with generally psychodynamic echoes of the American mental health hygiene movement in which all political and educational issues are aspects of health: an instance here being a paper on O. J. Simpson's first trial.

Beyond the classic issues such as when is pathology not pathology but "culture", there are articles on how Asian Americans' perception of being a "model" minority might cause high levels of morbidity; a characteristic paper on how post-traumatic stress disorder may be diagnosed only with difficulty among refugees (and which quite ducks the issue of whether the very idea of PTSD was an American medical solution to Vietnam veterans' response to their own atrocities); and how racial difference may affect the psychotherapeutic relationship. Consistent with the sense of "affirmation" is a paper proposing that Latino responses to bereavement may be more helpful than those of Anglo-Americans.

Not then for the theoretician, this is nevertheless a humane and most welcome journal. It would be an ideal place for their British counterparts to publish, particularly for those working in inter-cultural counselling and psychotherapy.

Roland Littlewood is professor of anthropology and psychiatry, University College London.