  This unificationist approach may be used to argue that the diagnostic entity itself is the same in all cases – some shared underlying process that adapts or responds to different cultural settings to produce different behaviors. Some scholars argue that the underlying abnormality, even if it exists, is beside the point. Our response to the condition should be determined by its expression, even if there is an underlying psychological kind. Kleinman argued that depression in the West and in East Asia are different enough in their expression and course that they should be seen as different conditions (1987, 450): “Depression experienced entirely as low back pain and depression experienced entirely as guilt-ridden existential despair are such substantially different forms of illness behavior with different symptoms, patterns of help-seeking, course and treatment responses that though the disease in each instance may be the same, the illness rather than the disease is the determinant factor.” 