Kirmayer Laurence J
Division of Social and Transcultural Psychiatry, McGill University, Montreal, Canada.
Psychopathology. 2005 Jul-Aug;38(4):192-6. doi: 10.1159/000086090.
The semiotic theory underlying psychiatric diagnosis views symptoms as more or less direct consequences of psychopathological processes. However, cognitive social psychology and clinical ethnography make it clear that symptom experience is embedded in culturally based systems of meaning and discursive practices. Physiological perturbations are organized, experienced and expressed in terms of a nested series of cognitive schemas involving knowledge about symptoms, illnesses or other models of affliction and broader sociomoral notions of self and personhood. Individuals have many competing schemas at their disposal. The relative prominence or weight given to a specific model is determined by the social context and purposes for which the person is reflecting on, recollecting or recounting their experience. Accounts of symptoms and illness experience are therefore highly dependent on the social context of narration. Psychiatric nosology and the process of clinical assessment must consider the ways in which psychopathology is shaped by social and cultural contexts including those of the family, workplace, and health care system as well as global professional, economic and political interests.
作为精神病诊断基础的符号学理论认为，症状或多或少是心理病理过程的直接后果。然而，认知社会心理学和临床人种志表明，症状体验嵌入在基于文化的意义系统和话语实践之中。生理扰动是根据一系列嵌套的认知模式来组织、体验和表达的，这些认知模式涉及有关症状、疾病或其他痛苦模型的知识，以及关于自我和人格的更广泛的社会道德观念。个体有许多相互竞争的模式可供使用。赋予特定模型的相对突出程度或权重取决于个人反思、回忆或讲述其经历时的社会背景和目的。因此，对症状和疾病体验的描述高度依赖于叙述的社会背景。精神病分类学和临床评估过程必须考虑社会和文化背景塑造心理病理学的方式，这些背景包括家庭、工作场所和医疗保健系统，以及全球专业、经济和政治利益。
