Culture, Psychiatry and Cultural Competence

Why the study of culture and its clinical application is important in mental health training and service? Mental health and illness is a set of subjective experience and a social process and thus involves a practice of culture-congruent care. Series of anthropological, sociological and cross-cultural research has clearly demonstrated a very strong ground in favour of this contention. An individual’s cultural background colours every facets of illness, from linguistic or emotional expression (Helman, 2007; Lewis-Fernandez, 1996) to the content of somatic complaints (Goldber & Bridges, 1988) and delusional (Yip, 2003) or hallucinatory experiences (Kim, 2006; Cowen, 2011). Cause, course and outcome of major psychiatric disorders are influenced by cultural factors (Kleinman, 1988; Kirmayer, 2001; Littlewood & Lipsedge, 1997). Wide variations in the prevalence of many psychiatric disorders across geographic regions and ethnocultural groups have been documented (Maercker, 2001). In mental health, dysfunctional behaviour is a key issue in diagnosis, viz. distinction from normal to disordered behaviour. The social and cultural context here is important because identification of abnormal dysfunctional behaviour is basically a social judgement (Kirmayer & Young, 1999). Different cultural and ethnic groups have different perception and practices about health as per their ecocultural adaptation (Weisner, 2002). Social and cultural factors are major determinants of the use of health care services and alternative sources of help. Recent changing global demography demands the recognition and response to cultural diversity in psychiatric practice (intercultural clinical work). Culturally based attitudes and assumptions direct the perspectives that both patient and clinicians constantly encounter in therapeutic communications (Moffic, 1983). Ethnicity, ethno-cultural identity, social class, cultural dimension of gender, cultural explanation and meaning of sufferings or illness, cultural codes of expression of distress, cultural value system and support network, cultural belief about religion and spirituality, cultural specificity in coping mechanism and ways of inter-cultural assimilation are the few broad issues in cultural psychiatry that helps to understand the clinical manifestation of psychopathology. Lack of awareness of important cultural differences can undermine the development of a therapeutic alliance and the negotiations and delivery of effective treatment. Following is a brief discussion on three important issues, viz. relationship between culture and mental health, cultural competence and cross-cultural communication and lastly the outline of cultural formulation in clinical assessment.