Sapolsky’s focus on society and culture and its influence on psychology and neuroscience reminded me of a literature review and presentation I did a couple of summers ago about eating disorders cross-culturally.  Common Western knowledge about eating disorders such as bulimia nervosa (BN) and anorexia nervosa (AN) suggests that these illnesses are the result of striving towards a thin ideal are and influenced heavily by the media.  This led some researchers to suggest that eating disorders are culture-bound syndromes, existing only within a Western cultural context.  Indeed, Westernization and globalization were assumed to be necessary for diseases like AN and BN to exist. Researchers Pamela Keel and Kelly Klump, however, found that Westernization and the thin ideal were not always present in cases of eating pathology. While the physical presentation of the disease were similar, the cognitions of the patients differed cross culturally. For instance, several girls from China and Hong Kong presenting physical symptoms of AN did not articulate a desire to lose weight and influence their body shapes. Instead, they voiced their loneliness and desperation. Importantly, one must only glance at the DSM IV-TR to see that the diagnosis of AN and BN are contingent on the Western understanding of the illnesses. Cross culturally, people understand illness in different ways.

Given cross cultural differences in understandings of disease, how can and should diagnosis occur? Likely most cultures have unique understandings of most diseases. What are the problems and benefits of Western diagnostic tools such as the DSM?

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