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Cultures in psychiatric nosology: the CCMD-2-R & international classification of mental disorders

  [ 59 votes ]   [ Discuss This Article ] • December 15, 1996

This essay reviews the Chinese Classification of Mental
Disorders, Second Edition, Revised (CCMD-2-R, 1995), by
assuming the theoretical stance that symptom recognition,
disease construction, and taxonomic strategy in psychiatry
reflect, and are constrained by, the cultural norms and values
as well as the political and economic organizations of the
society in which they are embedded. The CCMD-2-R is an
ethnomedical classification grounded in both symptomatology
and etiology, in which Chinese psychiatrists seek to conform
with international classifications on the one hand, and to
sustain a nosology with Chinese cultural characteristics on
the other. Although broad similarities between the ICD-10 and
CCMD-2-R are evident, their blending is legitimately
incomplete. Thus, the particular additions (e.g., travelling
psychosis, qigong induced mental disorders), deletions (e.g.,
somatoform disorders, pathological gambling, a number of
personality and sexual disorders), retentions (e.g., unipolar
mania, neurosis, hysteria, homosexuality), and variations
(e.g., depressive neurosis, neurasthenia) reveal not only the
changing notions of illness but also the shifting social
realities in contemporary China. The CCMD-2-R will be widely
used by Chinese psychiatrists and should standardize
diagnostic practice and facilitate research, but its impact
on everyday clinical work and psychiatric training remains to
be evaluated. For Western researchers, it is one avenue for
achieving an understanding of the Chinese social world, and
should usefully be contrasted with the ICD-10 and DSM-IV as
the move towards an international nosology continues.

Lee S

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