Idioms of distress, mental symptoms, syndromes, disorders and transdiagnostic approaches.

Euro-American idioms of distress and their corresponding symptom clusters have been universalised as mental disorders and are now the gold standard for psychiatric diagnosis around the globe. This paper discusses issues related to mental disorder diagnosis from a cultural perspective. It argues that psychiatric diagnoses, while having good inter-rater reliability, lack external validity. It contends that psychiatric categories and labels are supported by the current political economy of health. Nevertheless, it suggests that (i) all symptoms have a metaphoricity to convey a variety of distress, (ii) idioms are polysemious and have a capacity for multiple meaning and pragmatic implications, beyond local and cultural inferences, (iii) idioms of distress are performative, are a form of social action that effects social change, and are prone to improvisation of expression that is associated with adoption in new and changing contexts, (iv) psychiatric idioms are as easily accepted as local and folk beliefs and expressions, (v) idioms of distress are used for negotiating access to care, cure and healing across regions and cultures. The paper argues that new (psychiatric) idioms are easily adopted across regions and societies, and that they eventually change contexts and cultures.