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PARIS suggests that some cultures provide protective factors that can suppress the emergence of borderline personality disorder (BPD). Yet all cultures contain some individuals who perceive themselves as unable to meet what is expected of them, and the resultant distress is expressed through a variety of "ethnic" disorders such as susto or nervios. When viewed in this context, BPD is similar to these disorders, notably in the perceived sense of social failure, marginality and powerlessness.
Teasing out the cultural factors underlying borderline personality disorder (BPD) is a vexing task. Fortunately, Paris is undaunted and offers us his paper "Cultural Factors in the Emergence of Borderline Pathology." There he suggests that social factors can suppress the development of a diagnosable personality disorder, and that cultures differ in the extent to which they provide these protective factors. At first glance, there is little that seems new about this position, given the many studies linking social factors and psychiatric illness. We know, for example, that the incidence of psychiatric distress (including personality disorders) is linked to the degree of community integration or fragmentation (Leighton 1959, 1974). We also know from cross-cultural studies of schizophrenia that psychotic episodes are shorter and that relapse rates are lower in less technologically complex societies, most likely due to the integration of the ill member in the community (Hopper 1991; Leon 1989; Rin and Lin 1962; World Health Organization 1979). The importance of social role is further underlined by Warner (1985), who found increased recovery rates from schizophrenia in the West during periods when the labor market was tight and able to integrate these individuals.
We know, therefore, that sociocultural factors play a role in the emergence and course of psychiatric illness. Yet, the case material that Paris provides to support his thesis in relation to BPD is provocative in the sense that it asks the reader to reexamine the concept of personality and its sociocultural determinants. His implicit notion that we study late-onset cases as a means to better understand the interplay of factors in the emergence of the disorder is invaluable. As a means of elucidating cultural factors, however, the case material may be found wanting. It raises some nagging questions: How do we know that these women would not...