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The various normative elements implicit in the assessment of psychiatric disorder overlap, and much of what has been said above about the concept of harm, moral frameworks, and even the question of rationality could have its place in this section as well. Therefore, what I am going to do in this section is only to highlight the various cultural dimensions of psychiatry. These are assumptions and mechanisms regarding the causes of mental disorder, the impact of culture on diagnosis , specific differences in the individual experience of mental disorder, and last but not least the evaluation of behavior from the third-person perspective.

Culture or the character of a given society seems to influence the development and understanding of psychic problems both directly and indirectly; indirectly through the norms and social expectations the individual has to follow, directly through the expected ways of behavior which determine deviance. In an interesting article Catherine Caldwell-Harris and Ayse Ayçiçegi formulated a “ personality-cultural clash hypothesis ” according to which there is a correlation between personality-style, cultural character and mental health ( Clearance 100% Authentic Kate Spade New York Nadine Bow Sandals From China Sale Online LbQzXOuby
). They state that “[p]ersonality traits associated with psychopathology will be most frequent in allocentrics living in an individualist society, and in idiocentrics living in a collectivist society.” In collectivist societies where strict rules of social behavior have to be followed and social harmony is highly valued, people with an idiocentric (extremely individualistic) personality tend to have poorer mental health with high scores in paranoid, schizoid, narcissistic, borderline, and antisocial PDs. In individualistic societies, by contrast, a distinct allocentric (extremely collectivist) personality is positively correlated with social anxiety, depression, obsessive-compulsive disorder, and dependent personality. In addition to this indirect influence on mental disorder, there is a more direct influence, too. This can best be illustrated by Wakefield's account of cultural relativity:

“Whereas social phobia is a real disorder in which people can sometimes not engage in the most routine social interaction, current criteria allow diagnosis when someone is, say, intensely anxious about public speaking in front of strangers. […] This diagnosis seems potentially an expression of American society's high need for people who can engage in occupations that require communicating to large groups.”

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In sum, not only has the respective cultural setup an indirect influence on mental health, it also tends to dictate the boundary between the normal and the deviant on the basis of the expected values and virtues of its members. In this respect the impact of society on the concept of mental disorder is clearly normative. Whether the indirect influence, i.e., the personality-cultural clash, turns out to be directly normative under the surface after all remains an issue for further scrutiny.

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ROSEAU, 22 September 2017

In a rare live-blog from the prime minister of a country grappling with disaster, Dominica’s Roosevelt Skerrit described his own roof being torn off by Hurricane Maria. He has now confirmed 25 deaths and says his small Caribbean nation, population 73,000, will be building back “from zero”.

As soon as a fixed-wing aircraft could land at Canefield Airport near the capital, Roseau, IRIN on Thursday became one of the first news organisations to see the devastation first-hand, joining a team of international aid workers assessing needs and offering support.

Ben Parker/IRIN

At the airstrip, the shoreline is littered with huge yellow tree trunks. Seen from the air, the mountains are browned by the stripping of leaves; a flotilla of thousands more trunks and branches, stripped of bark, bobs in the turquoise waters.

In the capital itself, the atmosphere is edgy – a curfew has been set for 4pm to 8am, and there are reports of looting. Several officials say they’ve heard gunshots. Beyond criminality are tension, fear, and trauma, among people jostling to scoop water from burst water mains, still lacking news about their friends and family.

Roads are jammed with cars navigating tree trunks, crushed vehicles, and heaps of mud. A new bridge has collapsed. Police and soldiers guard key intersections and sites. Families are on the move with wheelbarrows and shopping carts in shock and desperation. In quieter neighbourhoods, after days of rain, some households are drying out their belongings in the sun.

Foreigners cluster in smashed-up hotels, at the stadium, and at the seaport, trying to get a ride out.

Ben Parker/IRIN

A Nigerian medical student, Adeleye Adeleke, tells IRIN he can’t find a replacement for his asthma inhalers, his landlady’s top floor is gone, he’s lost papers and possessions and he wants out – “right now”.

Adeleke says he saw the supermarket at the end of his street being looted but that security forces have regained control and set up checkpoints. But “there’s nothing to buy, no clean water to drink,” he adds.

Environmental health officer Selma Charles is “bunking up with a neighbour”. Her house? “Roof totally gone. Everything gone. Totally gone.” On the whole, she says Dominicans are pulling through, although it’s “really sad and painful”. In her professional view, the water safety issue is already becoming critical. “The water started smelling,” she says, adding that dead animals could contaminate the supply.

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