87 such a high percentage creates the risk of

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disorders to be characterised as “not otherwise specified”. 87 Such a high percentage creates the risk of defining as an illness any form of behaviour that seems unusual to a psychiatrist lacking cultural sensitivity. Why has the APA now endorsed as pharmaceutically treatable forms of behaviour that merely seem at odds with North American biomedical models, to the degree that cultural differences themselves now stand at risk of being even more readily medicalised? How should growing concerns about the culture-specific nature of diagnoses affect the APA’s claim that the DSM’s diagnostic categories transcend cultural barriers? In our opinion, worldwide wellbeing goals and the tendency to treat diverse culturally valued behaviours as new illness categories need to be redressed.
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The Lancet Commissions 1616 Vol 384 November 1, 2014 about their own ability and the effects of their actions. From the caregiver’s perspective, cultural factors cannot be ignored by labelling them as non-clinical or non- evidential because much of what is clinically possible is set by these very factors. Patient empowerment and related self-help strategies are useful only for those who believe that they have the capacity to affect health by taking responsibility for themselves; for those who do not feel—or are not—empowered, quite different strategies are needed to improve wellbeing, and these strategies, in general, rely on opportunities for person- to-person engagement and building of trust. Because competence is about identification and interpretation of the unknown, it has not been furthered, and might have been hindered, by an exclusive focus on medicine’s evidence base. Although development of best practices from what has already been tested is laudable, an obsessive focus on evidence also means valuing what is known at the expense of what is not yet known, what might not be known, or, indeed, what might not ever be clinically knowable. A thing in the making, by definition, cannot be fully known by straightforward recourse to existing formulas or normative theories. 92 Curiosity is key to innovation. Use of normative decision-making techniques can, therefore, have disastrous effects. This issue is shown by many well-intentioned, competence- improving initiatives that teach culture reductively, exacerbating already harmful stereotypes. 92,93 Although anthropologists try to avoid approaching culture as stereotypical and fixed, many medical educators do not. Medical school initiatives and caregiver training programmes often reduce individual behaviours to broad stereotypical formulas, or at least encourage such stereotyping by applying specific behaviours to categories of people. Broad truths might exist on which such generalisations are based—for example, many German people relate low blood pressure to a weakening of the heart, and fear it more than most. But generalisations should be accepted cautiously, with the realisation that individual responses to norms vary widely. One of our main concerns, then, is the question
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  • Summer '18
  • Jeanne Hughes
  • Lancet

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