The Oxford Dictionary defines Diagnosis as “the identification of the nature of an illness or other problem by examination of the symptoms.” Tanya Luhrmann, Angela Garcia, and Cristiana Giordana all deal with the concept of diagnosis in their works. They ask us to consider what the purpose of a psychiatric diagnosis is, and what diagnosis and treatment can look like in different settings. In doing so, they draw upon the framework of critical psychiatry, which investigates psychiatry as a culturally embedded, politically charged institution and seeks to understand how mental illness is defined and treated by analyzing the social and historical processes behind psychiatric practices. Psychiatry as an institution is still evolving, and western-centric practices like the DSM do not take into account what mental illnesses can look like in different cultures because Western diagnostic systems reflect Western assumptions about normalcy and pathology rather than universally applicable understandings of mental suffering. Ultimately, across diverse psychiatric settings, diagnosis functions less as an objective identification of pathology and more as a culturally and politically mediated tool that organizes suffering, legitimizes intervention, and reflects broader structures of power. 

In her work “What’s Wrong with the Patient”, Luhrmann discusses the classical Western process of psychiatric diagnosis and identifies misconceptions others have about the process as well, but the way that she defines it is different from some other anthropologists. Most people assume that diagnosis is a simple process of identifying symptoms and matching them to a disease, but in reality it is far more complicated. Luhrmann explains that psychiatrists have to have a strong intuition about mental illnesses: “the capacity to recognize patterns in body and behavior that are relevant to clinical problems, to see what is wrong with a patient, to judge the severity of the problem, and to choose an intervention that leads as quickly as possible to the patient’s recovery” (Luhrmann 34). The key point here is that one of the goals of diagnosis is to help narrow down on an intervention to help the patient’s recovery—not to necessarily fit the patient into a perfect category. From a critical psychiatry perspective, Luhrmann’s analysis reveals that psychiatric diagnosis operates less as a fixed biological science and more as an interpretive practice shaped by professional judgment and institutional demands. Her work exposes how psychiatric authority often depends on managing uncertainty rather than resolving it. In fact, psychiatry is such a changing field that “challenging the categories does not challenge the existence of organic disease… there’s too much time and energy wasted on trying to redefine everything” (Luhrmann 51). Luhrmann is correct that more important than perfect definitions and diagnosis is helping the patient, but her understanding of the diagnostic process is also very different from that of Giordano’s in her book Migrants in Translation (specifically the chapter on “The Tightrope of Culture”). Giordano explains that diagnosis “takes into account multiple voices, and it aims at serving a purpose for the patient, such as being able to name his/her suffering in a way that can be heard and shared by family members and people back home” (Giordano 61). While both Giordano and Luhrmann agree that the purpose of diagnosis is to help the patient, the processes they focus on are different—ethno-psychiatry versus traditional psychiatry respectively—and reveal the cultural differences that make the different methods necessary.

Giordano focuses on ethno-psychiatry in Italy and how it is used to help immigrants who have been through traumatic events, and how ethno-psychiatry is uniquely poised to assist them in a way that regular psychiatry cannot. The process of ethno-psychiatry involves practitioners working to find an intermediate space between biomedical diagnostic criteria and a patient’s ways of expressing suffering, and as a practice, critiques how the state can reduce the “other” to stereotypical categories (Giordano 38). Giordano critiques the universalizing tendencies of Western psychiatry when demonstrating how suffering cannot be neatly translated into standard biomedical categories, and ethno-psychiatry both conforms with and resists the state’s attempt to reduce suffering to administrative labels. Luhrmann and Giordano both point out that in psychiatry, patients have a “different relationship to their symptoms” and don’t always answer questions cleanly (Luhrmann 33), and that this gap in patients’ language can be understood as a trauma response (Giordano 35). By creating space for a patient’s culture in allowing them to talk about their symptoms and name their suffering as they understand it, ethno-psychiatrists create space where “the unsaid of the patient’s story can be articulated, or at least can be heard as silence or seen as bodily signs” (Giordano 45-46). 

Giordano brings up the examples of two women, Mary and Grace, whose conditions cannot be explained solely through either biomedical diagnosis or cultural beliefs; their suffering is the result of an intersection between the two. Mary was terrified of people finding out about her HIV positive status and her lack of residence permit in Italy, but also believed that her HIV was a consequence of a voodoo spell cast on her while she was pregnant. Her belief in voodoo and how it had hurt her physically and killed her husband was her cultural way of understanding physical symptoms like difficulty sleeping, an ongoing echo in her ears, head pain, and more, and the ethno-psychiatrists helped translate this discussion into a possible depression diagnosis. Grace, on the other hand, did not migrate willingly like Mary, but was trafficked when she was a teenager and sold into prostitution, where her madam performed a voodoo ritual on her and was physically abused and sexually assaulted. Grace’s blamed the voodoo again for her symptoms: uncontrollable seizures, suicidal tendencies, hearing voices, and paralysis. The ethno-psychiatrists, by examining her symptoms but also the cultural context she used to describe her status, were able to diagnose it as “psychotic syndrome linked to her prolonged exposure to serious psycho-physical traumas”, and it is doubtful that they would have been able to come to this conclusion and translate her talks of voodoo into this biomedical framework without their training (Giordano 52). In all of these scenarios, diagnosis is not nearly as straightforward as discussed by Luhrmann; it requires special training, interpretation, and intuition, and while these diagnoses helped both Mary and Grace, it is unsure if they would hold up outside of that cultural context. Psychiatry is also politically charged here; one of the purposes of the diagnosis is to categorize these women into the box of “victim” and thus move from there to treat them, and while it does allow them to get necessary help, the label does not always fit. Some of the women were not trafficked, but chose to immigrate, or got caught up in traumatic circumstances in dubious ways. The context is incredibly important.

Garcia’s paper “Serenity: Violence, Inequality, and Recovery on the Edge of Mexico City” helps elucidate on how context is important for understanding non-traditional methods of treatment for mental illness. In relation to Giordano’s statement that culture is understood as “both a reassuring and violent set of symbols, simultaneously providing coherent and incoherent meaning to patients’ experiences,” Garcia examines the cultural context behind violence as a method of treatment and recovery for mental illness (Giordano 41). Her paper discusses anexos, institutions in Mexico that are part 12-step program, mental asylum, prison, and church to assist people with mental illnesses. Anexos have been criticized by human rights organizations for the violence inherent to their treatment—yes, there is exercising, praying, group therapy, and counseling, but there are also beatings, coercive methods of getting people to the anexo, humiliation, and more. Padrino Francisco, interviewed for the paper, recalls that he “was a fucking ashtray, They put their cigarettes out on [him]. If I moved or yelled they kicked me… [he] learned to be still.” (Garcia 465). While this violence can absolutely be criticized, it ignores the cultural context around the anexos. The violence and coercion inherent to this form of treatment exists because the state left impoverished communities with no other options. Violence is not exclusive to anexos, it is embedded in their community and lifestyle, shaped by the same war on drugs and poverty that destroyed their neighborhoods to begin with.

This criticism ignores the cultural context around said treatment. Because of this, “the work of recovery is sometimes supported by violence itself and where physical pain potentiates healing” (Garcia 456). In this context, violence became a method of recovery whereby the individuals, described as being in a state of “half-death”, used the pain to confront the boundary between life and death, which helped them relearn how to live better lives. The violence forced them to face their trauma, rather than avoid it. Garcia explains that there are 1000-4000 anexos versus only 500 certified rehabilitation centers—what then, are the other options? To look at anexos devoid of cultural context is to ignore decades of power-laden processes that have directly hurt Mexico at in order to benefit wealthier countries looking to take advantage of their resources; to ignore poverty and economic uncertainty for which there are no clean solutions. In this scenario, diagnosis with a mental illness like addiction is directly used to justify forced treatment at anexos, and diagnosis takes on a position of power over the patient that it does not have in other contexts. Anexos are ultimately a radical example of how psychiatric care emerges outside formal biomedical systems when institutions fail.

While Luhrmann, Giordano, and Garcia all approach mental illness through distinct ethnographic settings, together they reveal that psychiatric diagnosis is never merely a neutral medical process but rather a culturally and politically situated practice shaped by institutional priorities. Luhrmann demonstrates that even within Western psychiatry, diagnosis depends heavily on intuition, interpretive uncertainty, and pragmatic intervention rather than purely objective classification. Giordano extends this critique by showing that for migrants, diagnosis must also function as cultural translation, requiring practitioners to negotiate between biomedical frameworks and patients’ own symbolic understandings of suffering. Garcia pushes this argument further by illustrating that under conditions of structural violence and state abandonment, formal diagnosis can either become secondary or function as leverage over a patient, allowing for therapeutic systems like anexos that prioritize survival and recovery over psychiatric categorization. Together, these authors challenge universalized assumptions about mental illness by showing that diagnosis is not simply about identifying pathology, but about managing suffering within specific social, political, and economic contexts. The only way for the treatment of mental illnesses to be perfect is for the world to be perfect, for people to not be traumatized by human trafficking and prostitution or forced immigration, or live in countries not beset by constant violence and poverty and economic uncertainty. If I was given a chance to talk to these anthropologists, I would ask them a few questions. What can diagnosis look like in settings like anexos, that don’t necessarily conform to formal psychiatric standards? Are there possibilities for embedding ethno-psychiatric training into regular psychiatric training, so that individuals do not have to purposefully seek out psychiatrists from similar cultures just to find someone who can help them? Are there changes that should be made to the current DSM and diagnostic process that could make the psychiatric process more inclusive?