In some cultures, symptoms of depression are not generally recognized as a case for mental disorders. In addition, symptoms of depression might be presented in somatic terms rather than sadness or guilt (Castillo, 1997). For example, among Latin American and Mediterranean cultures depressive experiences might be manifested in terms of complaints of "nerves" and headaches; Asians may show similar experiences in terms of weakness, tiredness, or "imbalance," whereas among people from the Middle East and American Indian tribes these experiences might be shown in terms of difficulties with the "heart" or being "Heartbroken," respectively (see DSM-IV, 1994, pp. 324-325). The severity of the depression might also be evaluated differently across cultures (e.g., sadness may lead to less concern than irritability in some cultures). Hallucinations and delusions, which are sometimes part of Major Depressive Disorder, should be differentiated from cultural hallucinations and delusions (e.g., fear of being hexed, feeling of being visited by those who have died). In Table I, the culture-bound syndromes "brain fag" and "susto" may resemble symptoms suggesting Major Depressive Disorder (DSM-IV, 1994, p. 486, p. 849).
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