Some Old Questions for the New Cross‐Cultural Psychiatry

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Abstract
The WHO cross‐cultural studies of schizophrenia exemplify both the achievements and the pitfalls of large‐scale psychiatric epidemiology. Their logistical and technical advances have been justly celebrated; the consistent—and unexpected—finding of better outcome in the developing than in the developed world continues to vex analysts. At the same time, anthropological critics have not been shy about pointing up the limitations and blind spots of such research. Criticisms range from charges of ethnocentrism and category errors in the psychiatric research enterprise itself especially the inapplicability of its disease taxonomy to some non‐Western cultures, to translation difficulties, the suspect and “thin” quality of questionnaire‐generated accounts of illness, disregard for variant understandings of the “self,” and the naïveté of treating culture as a set of variables. Not all of these objections, I argue, are well‐founded; some more properly reflect persisting instabilities in anthropological theory. This critical commentary all but ignores the striking epidemiological findings in the West that dispute the received wisdom of chronicity as the natural trajectory of schizophrenia. A natural alliance awaits realization between clinicians—newly alerted to ill‐understood factors affecting course and outcome—and fieldworkers—bent on close ethnographic analysis of the configurations and roles of beliefs, work, kin‐based support, the uses of public space, and “the natives”‘ own understanding of what ails them.

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