David Ricardo: la doctrina clásica de la renta; el sistema ricardiano y sus críticos

Most of the arguments on the development of psychology in Malaysia are centred on the lack of locally trained psychologists, recognition of clinical psychologists as professionals in the Malaysian public service, and cultural appropriateness (Rahmattullah Khan, 2008; Scorzelli, 1987; Wan Rafaei, 1996; Ward, 1983; Zakaria & Asyraf, 2011). As for the appropriateness of the psychological knowledge in Malaysia, with reference to the Diagnostic and Statistical Manual of Mental Disorders (DSM), there are tensions in the constructs of the classification system that is dependent on the Western knowledge system. The system of classification is inconsistent with the local Malay cultures, values and practices. Marsella and Yamada (2010) argued that,

it is essential we recognize that Western mental health professions and sciences are a ‘cultural

construction’. As such, they must be seen as relative to the historical, linguistic, and socio-

political influence of Western cultural traditions, and as such, they should not be considered

‘objective’, but rather representations of cultural knowledge and practice (e.g., ontogenies,

epistemologies, praxiologies) rooted within Western cultural traditions. (p. 106)

Drawing from Marsella and Yamada’s argument the culturally specific construction of mental

health knowledge, it can be understood that mental health knowledge highly depends on socially decided norms and values, which coincide with the cultural context of its emergence. Hence, evidence-based practices of mental health issues developed in Western countries may not be culturally appropriate, feasible or effective in other contexts. Consistent with this concern, philosophers and mental health professionals have echoed the need for socio-cultural consideration in dealing with psychological disorders since the early development of modern psychology. For example, in 1904, after a series of visits to non-Western groups in Southeast Asia and the Lakotah Indian tribes, Professor Emil Kraepelin, (1856-1926) also known as father of modern psychiatry, concluded that his classification and diagnostic system of mental disorder was not as universal as it

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had been argued and that the knowledge generated appeared to have little applicability to non- Western groups (Marsella, 2012).

This historical evidence suggests the need for further interrogations and the formulation of new ideas so that the system of classification of mental disorders would be meaningful in cross- cultural settings. Furthermore, these new ideas will also generate knowledge that can be used not only for diagnostic purposes but to develop culturally-tailored interventions (Yamada & Brekke, 2008). Accordingly, the acceptance of the current epistemology of mental disorder in Malaysia needs to be reconsidered and re-evaluated so that the knowledge is appropriate to the local historical, political and socio-cultural traditions.

The issue here is that in Malaysia, the unique classification of mental health has not yet been established, leading to a reliance on the Diagnostic Statistical Manual of Mental Disorders (DSM), which was developed in the West. While the DSM offers no formal procedure for assessing the

relative impact of specific contexts on an individual’s experience of the diagnosed disorder (Bitsika,

2005), it is clear that if it is to be useful, it needs to support clinicians to review culture in a systematic way, and to pay attention to the cultural aspects of presentation and interactions in psychiatric diagnostic practice (Baarnhielm & Rosso, 2009). A cultural formulation is characterised

as a, “culturally focused idiographic approach to complement the nomothetic approach of DSM-IV”

(Baarnhielm & Rosso, 2009, p. 408). The emphasis is on the relationship between culture and the diagnostic system taking care to reflect the practices in cross-cultural settings.

Given the limits of the DSM categorisation with regard to cultural appropriateness, it raises the question of how it is possible to make use of the research on conduct disorders in culturally relevant ways. How might it be possible to reconceptualise the meaningfulness of diagnostic criteria for the benefit of Malay adolescents? The main limitation identified in the criteria for Conduct Disorder as presented in the DSM is that, they are nomothetic in nature, which describes the development of the criteria based on generalised norms from series of cases, supposedly governed by universal law (Baarnhielm & Rosso, 2009). These norms are culturally embedded and reflect the context of their origin (Marsella, 2012). Therefore, this approach is unlikely to account for

individual’s experience of the allocated diagnosis and does not account for the cultural specificity of the ability to function in day-to-day life (Bitsika, 2005). Because this approach focuses on identifying specific symptoms in isolation from the context in which they occur, it does not quantify or describe the environmental factors that impact on the expression of these symptoms. It denies the fact that mental disorders are a result of complex interactions between an individual and their

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environment. Furthermore, the trend of the interaction is unique between one and another. Hence, if the normative data are the main substance in the classification system of mental disorders, it also

means that it denies the importance of the “reflective self-consciousness” (the individual’s evaluation

of the environment and it’s role in understanding of his or her behaviour) (Bitsika, 2005) that reflects the idiographic commitment.

The discussion on limitations of the nomothetic approach suggests that the symptoms of Conduct Disorders should have, at least in part, the elements of cultural specificity. Therefore, the idiographic approach should be incorporated to make more sense of Conduct Disorders diagnosed in individuals within their cultural context, especially for the Malay in the Malaysian context (Wigman et al., 2013). The focus of an idiographic approach is to complement the nomothetic approach of the DSM. The idiographic approach in classifying mental disorder focuses on individual and unique cases such as symptoms that are unique to any particular individual or context (Wigman et al., 2013). In this respect, the classification of conduct problems in a specific cultural context needs to be merged with the standardised classification system of Conduct Disorder as presented in the DSM. Having the different paradigms of nomothetic and idiographic approaches, it can be assumed that Malay adolescents will not experience the disorder similar to many others who are diagnosed with the same disorders, from different cultural contexts. It also suggests that the Malay adolescents who are diagnosed with Conduct Disorder are most unlikely to benefit from a universal standardised treatment.

Despite these limitations, the DSM offers space for developing a cultural formulation by bridging nomothetic and idiographic aspects in the classification system as a strategy in making DSM relevant to other cultures, given that DSM remains the authority in legitimating the process of diagnosing and classifying mental disorders. Having said that, if we understand mental disorders as a cultural construction (Marsella, 2012), it should enable us to question whether the classification system of mental disorders can be holistically meaningful in cultural contexts that differ from the culture of its origin. Holistically in this sense refers to not only the classification criteria but also its development process. Taking up the DSM without question would mean to recognise its legitimacy without considering our own culture to determine our lived experiences. The DSM is still important as it provides a structure for understanding conduct disorders, particularly against the background of globalisation. Therefore, it is our job to critically analyse the structure to produce knowledge for our own interpretation of mental wellbeing.

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