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Mental health practitioners

The DSM-IV notes that the “duration and expression of ‘normal’ bereavement vary considerably among different cultural groups”. A major depressive episode is diagnosed, instead of bereavement, if symptoms of depression are present two or more months after the loss or the following symptoms are present: a) guilt about things other than actions taken or not taken by the survivor at the time of the death; b) thoughts of death other than the survivor feeling that he or she would be better off dead or should have died with the deceased person; c) morbid preoccupation with worthlessness; d) marked psychomotor retardation; e) prolonged and marked functional impairment; and f) hallucinatory experiences other than thinking that he or she hears the voice of, or transiently sees the image of, the deceased person. These symptoms are based on a Western construct for the diagnosis of abnormal grief and as such do not take into account different cultural expressions of grief. In many cultures, it is normal to be visited by spirits and ghosts, and people of non-Western culture may describe conversations with supernatural spirits. The importance of placing these expressions of grief in the appropriate cultural context is essential in differentiating between abnormal and normal reactions to loss. Inappropriate diagnoses of psychotic disorders, post-traumatic stress disorder (PTSD) and mood disorders have been made in people of non-Western backgrounds when clinicians ignore cultural differences in the expression of grief. The misdiagnosis and subsequent inappropriate treatment will at best not address the issue for the affected person and, at worst, cause harm.