240 Timothy J. Beck and Jacob W. Glazier
always accounting for local languages and norms. In predominantly
Arabic-speaking countries like Egypt, for instance, there is no direct
equivalent to the word ‘anxiety,’ and as such it is often translated as
‘worry,’ which does not carry the same connotations. Movements toward
the globalization of Western psy-disciplines are thus inherently laden with
ethical and conceptual concerns that are all too often ignored by
practitioners and researchers (Cosgrove & Karter, 2018).
The V-codes listed in the fourth and fifth editions of the DSM provide
another instructive example of how culture is understood within psy-
disciplines. These are non-billable codes that are not recognized as
disorders in the sense of being a psychological abnormality but are,
nevertheless, still listed in order to account for problems, issues, or
contextual factors that perhaps contribute to the rendered diagnosis. Such
issues might include partner relation problems or child abuse. It is worth
noting here that despite these attempts to account for sociocultural factors,
taxonomies like the DSM and the ICD nonetheless position an official
diagnosis as central to treatment. Descriptors related to bereavement,
family conflict, and socioeconomic status are attached merely as secondary
pieces of information.
The DSM-5, moreover, builds upon earlier attempts to account for
culture with the development of a cultural formulation interview (Lewis-
Fernández et al., 2014). This represents a more concerted attempt to collect
details about clients’ lives beyond their symptoms in ways that might
inform diagnosis and treatment decisions. By way of contrast, a critical
approach to abnormality would argue that sociocultural factors such as
those represented by the V-codes (DSM) and Z-codes (ICD) of the
diagnostic manuals are, in fact, more primary in the expression and
abatement of suffering than the more abstracted formal diagnosis. Given
the mounting critiques of how sociocultural factors have conventionally
been marginalized in the criteria for diagnoses in the DSM (see, for
instance, Karter & Kamens, 2019), new ways of thinking through the
social dimensions of mental suffering and wellbeing are emerging both
within and outside of professional care settings.