"Ethnopsychiatrists have consistently maintained that the perceptions, inclinations, and behavior of mentally ill persons are never a simple reflection of their illness: the mentally ill tend to behave in some ways in some cultural contexts and in other ways in others. This pathoplasticity shows, we are told, that abnormality is, primarily, the manifestation of a phenotype, not a genotype. Hence, any diagnosis and treatment of the affected individual must be grounded in some knowledge of the environment within which he or she functions. Postulating the existence of such an intimate and harmonious connection between psychopathology and social conditions, however, overlooks a pivotal distinction: while it is true that local norms and values can and do affect most neurotic presentations, those same standards have at best a marginal influence on psychotic reactions. Some pathogenic features are so overwhelming that they will be expressed in any environment. Accordingly, I conclude, we shall have progressed significantly in our understanding of the nature of mental disorders once we begin to associate neuroses with culture and psychoses with biology."