Language, Culture and Psychopathology: ConceptuaL and Methodological Issues

In recent years, the World Health Organization has developed scheduled interviews in order to make psychiatric diagnoses that are comparable across languages and cultures. These scheduled interviews include the technician-administered Composite International Diagnostic Interview (CIDI) and the psychiatrist-administered Schedule for Clinical Assessment in Neuropsychiatry (SCAN). Work on these interview schedules in numerous languages has demonstrated the importance of lay terminology in eliciting the presence of psychiatric symptoms and in assessing their severity. Lay terminology regarding subjective experiences and perceptions is strongly tied, through language, to cultural values, attitudes, norms, beliefs, and customs. In this review article, we outline critical concepts and methods regarding psychopathology, language, and culture. General concepts relevant to these matters are defined and discussed: e.g. denotation, connotation, various types of equivalence in translated materials, specificity of terms, and reporting threshold in relation to symptom severity. In addition, methods for ensuring equivalence of words, items, and instruments across languages and cultures are presented: e.g. methods of translation, back translation, bilingual test-retest, re-norming, and re-validating. Other assessment topics related to culture and psychiatry include confidentiality, choice of a language for assessing multilingual patients, methods of eliciting certain psychological experiences (e.g. hallucinations, delusions), culturally taboo topics, and cultural nuances regarding mental status examination.