Modern biomedical psychiatry is the product not only of scientific enterprise but also of the progressive secularisation and medicalisation of moral life in the West (Jimenez, 1987). Psychiatry is an evolving cultural product. Its diagnostic categories represent pathologies rooted in Western notions of self, identity, normality and abnormality (Gaines, 1991). Psychiatric practice in Egypt, on the other hand, is the product of two different and often incompatible world views, namely Western psychiatry and Egyptian concepts of self, identity, normality and abnormality. The task of the psychiatrist in Egypt is to negotiate symptoms and diagnoses in a way that is sensitive to the demands of these two competing cultural streams. Analysis of this process provides a unique view of the ways in which culture can have an impact on professional psychiatry in any society or ethnic context.

A news release from the World Health Organization (2003) suggested that a mere 10% of global health research is devoted to diseases that account for 90% of the global disease burden. While this comment refers primarily to research into infectious and parasitic diseases, a similar trend may well be true for psychiatry, taken from a global perspective. A cursory glance at recent issues of World Psychiatry, the official journal of the World Psychiatric Association, will reveal articles describing recent advances in antidepressant treatment and other pharmacotherapies, psychotherapy and psychoanalysis, personality disorders, attention-deficit hyperactivity disorder, and the genetics of mental illness. These topics are obviously important and the field cannot advance without such cutting-edge research. Most of the authors are, as expected, psychiatrists living and working in Western Europe or North America. This is also, of course, acceptable and important. The dissemination of scientific data is essential for advancing the field, and researchers who live and work in Europe and North America are generally the most qualified to do so. So, what's the problem?

Cultural psychiatry as a clinical specialty sprung mainly from Europe and North America, in order to respond to growing concerns of ethnic minorities in high-income countries. Academic psychiatrists pursuing comparative international studies on mental health, together with medical anthropologists conducting clinical ethnographies, contributed to its theoretical basis (Kleinman, 1987; Littlewood, 1990). What at first appeared to be a marginal specialty is no longer so. For example, the UK alone has witnessed a steady growth of the field, as evidenced by its mandatory inclusion in mental health training curricula, and the existence of several taught masters courses, academic positions in universities and three dedicated journals, as well as, more recently, lead papers in mainstream publications that have debated the cultural position of ‘biology’ itself (Timimi & Taylor, 2004). Additionally, with a proliferation of clinical jobs for ‘ethnic minority’ services in hospital trusts across the country, there is ample scope for employment. The overall evidence indicates that ‘cultural psychiatry’ in the UK is now a specialty in its own right.

Ethiopia, in the Horn of Africa, is one of the ancient independent nations of the world and has a rich diversity of peoples and cultures. The country covers 1.1 million km2 (Central Statistical Authority, 2000a). It has a population of about 70 million people (Central Statistical Authority, 2002), 80 different ethnic groups and some 200 dialects. Ethiopia is the second most populous nation in sub-Saharan Africa, after Nigeria (Hailemariam & Kloos, 1993). Forty-eight per cent of the population are under 15 years of age and over 80% live in rural areas (Central Statistical Authority, 1995). Islam and Christianity are the main religions.

Israel is a multicultural society in a state of permanent change. The population, of about 6.5 million, comprises the following religious groupings: Jews (77.5%), Muslims (15.3%), Christians (2.1%), Druzes (1.7%) and others (3.4%). The organisation of and the approaches used by the country's health services have been determined by this sociocultural plurality, and also by a continuous influx of immigrants (among whom, 882 600 and 44 200 arrived from countries of the former USSR and Ethiopia, respectively, between 1990 and 2001), as well as by the precarious security situation (the country has seen several wars with its neighbours in addition to the long-standing conflict with the Palestinians). The patterns of care of the population reflect both Western psychiatry and traditional systems. Because of such complexity, the present brief overview is necessarily selective.

Albania, situated in the western Balkans, has an area of 28 748 km2 and a population of 3 069 275 (year 2001), almost one-third of whom are aged 0–14 years. Life expectancy is estimated to be 70.4 years for both sexes (World Health Organization, 2003a). According to the World Health Organization's classification, Albania is a country with low child and low adult mortality rates. The nation's total expenditure on health in 2001 amounted to 3.7% of gross domestic product.

One of the challenges of medical practice is to resolve the conflicts that arise when a professional is required to choose between competing ethical principles. This is especially true in psychiatry. The answers to ethical issues are not necessarily right or wrong. Ethics in psychiatry is complex, and numerous dilemmas may confuse the picture. Clinicians and researchers bring their own values to the scenario, but they must also deal with the values of their colleagues and their patients, as well as those of the wider (multicultural) community. These conflicts traditionally concern confidentiality, informed consent, involuntary hospitalisation, the right to treatment, the right to refuse treatment and the regulation of psychiatric research, among others. These are universally encountered but present differently across the regions of the world.

There has been a rapid rise in the number of people with mental disorders. These disorders represent a major challenge to global development. The burden will be higher in developing countries, which have the least resources to respond. World-wide, 450 million people are affected at any given time. No group is immune to mental disorders but the risk is higher among: the poor; children and adolescents; abused women; the unemployed; persons with little education; neglected elderly people; victims of violence; migrants and refugees; and indigenous populations.