The implications of genetic variation conferring plasticity - as opposed to vulnerability - not only reinforce the importance of recognizing dynamic bio-psychosocial models, but suggest the need to reconsider the relative role(s) of culture when seeking to understand how disorders are manifest. Perhaps most important is the need to do so in a way that does not assume that one set of cultural/environmental variables are suitable for the entire range of diverse genotypes and endophentotypes encountered. Beyond cultural relativism, the enormity of potential combinations of gene combinations and environments calls for psychiatry to account for individual differences according to an individual's own array of factors (for example some form of 'personalized medicine'), and still retain something akin to group validity and/or generalizability. We posit that concepts of bio-psychosocial spectrum disorders are well-suited to this. However, we also advocate caution against assuming that one treatment model is optimal for individuals grouped either by genotype or culture, because individual endophenotypes likely depend upon complex interactions of these (genetic and environmental) factors.
Therefore, when regarding both models of susceptibility to plasticity, and neuropsychiatric spectrum disorders, a new line of inquiry emerges into the co-evolution and co-determination of socio-cultural contexts and endophenotypes, and further, into the consequences of displacing bio-psychological characteristics to various socio-cultural milieu . This is particularly relevant since, as Brüne notes, the medical model of psychiatry is becoming increasingly popular and utilized in non-Western countries where differing socio-cultural 'set points' may accommodate the prevalent regional endophenotypes. Moreover, while human genetic traits and culture have evolved for tens of thousands of years, the large-scale socio-cultural shifts of the past century have made it difficult to account for, much less predict, how changes in environments and social structures will affect neuropsychiatric function. These shifts in environmental and socio-cultural variables are occurring on a global scale, and not all genotypes and endophenotypes will be equally susceptible to potential advantages and/or deprivations disposed or evoked by such rapid and radical change.
We argue that this compels the need to understand concepts, constructs, and effects of norms in a more complex and relative sense; else there is risk of psychiatric ethnocentrism incurred by conflating values that contribute to optimum functioning of one particular population with 'universally favorable' values. This would have detrimental consequences for individuals who may be better suited to a different approach to their bio-psychosociocultural contexts, as it is becoming clear that neurobiological diversity is desirable in the face of challenges presented by cultural shifts (in family structure, communication, social support, the volume and manifestations of ambient sensory stimuli, economics, and so on) [20–22]. So, while stress-diathesis, vulnerability-centered models of psychiatric disorders may have utility in understanding how these socio-cultural and neurobiological variables interact to generate disease, disorder, and dysfunction, as Brüne explains, it is also necessary to consider the good as more than merely an absence of adversity and disorder if the goal is to facilitate true flourishing, and not just the mitigation of suffering.