The psy fields are predicated on the cartesian notion of a mind-body dualism.Suffering is understood to stem either from problems of mind or from problems ofphysiology. A related dualism is that of the “biological” and thatof “cultural”. Recent commentators have worked at great length tocollapse this dualism in day to day work with patients. At the same time, itclearly forms a fundamental part of medical epistemology. From a transculturalperspective, it is increasingly clear that there exists the possibility forconsiderable difference in the four “Es”: Experience, expression,explanation and expectations related to suffering. This variation is in largepart related to the epistemic structure underlying any given culture, and, takenas such, can present a considerable challenge to consultation-liason psychiatry.A patient may experience suffering that is expressed in the form of strangesensations in a specific parts of the body. This is then explained as aconsequence of a certain process that is culturally syntonic, and then expects acertain course of suffering as well as treatment. Given that we tend to take ourepistemic perspectives for granted as representative of the “world as itis”. The C-L psychiatrist who does not take these variations intoconsideration could all to easily arrive at a misdiagnosis and as sucherroeneous treatment.