Cultural Assessment in Clinical Psychiatry (Gap Report (Group for the Advancement of Psychiatry))

202 Pages·2002·0.91 MB·English

by  The Group for the Advancement of Psychiatry

Cultural Assessment in
Clinical Psychiatry
Committee on Cultural Psychiatry
Ezra Griffith, M.D., Chairperson
Renato D. Alarcón, M.D., M.P.H., Project Coordinator
Irma Bland, M.D.
Prakash Desai, M.D.
Edward F. Foulks, M.D., Ph.D.
Frederick Jacobsen, M.D., M.P.H.
Roberto Lewis-Fernandez, M.D.
Francis Lu, M.D.
Maria Oquendo, M.D.
Pedro Ruiz, M.D.
J. Arturo Silva, M.D.
Ronald Wintrob, M.D.
Joe Yamamoto, M.D.
Trevia F. Hayden, M.D. (Fellow)
Robert L. Harvey, M.D. (Consultant)
J. Charles Ndlela, M.D., M.P.H. (Consultant)
Dora Wang, M.D. (Consultant)
Cultural Assessment in
Clinical Psychiatry
Formulated by the
Committee on Cultural Psychiatry
Group for the Advancement of Psychiatry
Report No. 145
Washington, DC
London, England
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Copyright © 2002 Group for the Advancement of Psychiatry
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Library of Congress Cataloging-in-Publication Data
Cultural assessment in clinical psychiatry / formulated by the Committee on
Cultural Psychiatry, Group for the Advancement of Psychiatry.
p. ; cm.—(Report ; no. 145)
Includes bibliographical references and index.
ISBN 0-87318-144-1 (alk. paper)
1. Cultural psychiatry—United States. 2. Psychiatry, Transcultural. I. Group
for the Advancement of Psychiatry. Committee on Cultural Psychiatry.
II. Report (Group for the Advancement of Psychiatry : 1984) ; no. 145.
[DNLM: 1. Community Psychiatry. 2. Cross-Cultural Comparison.
3. Cultural Characteristics. 4. Cultural Diversity. WM 30.6 C9676 2001]
RC455.4.E8 C788 2001
616.89—dc21
2001027936
British Library Cataloguing in Publication Data
A CIP record is available from the British Library.
Contents
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vii
1 Culture in Clinical Psychiatry: History and Scope . . . . .1
2 Cultural Variables . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
3 Cultural Formulation: Description and Clinical Use. . . 53
4 DSM-IV-TR Cultural Formulation Applied to
Six Clinical Cases . . . . . . . . . . . . . . . . . . . . . . . . . . . 65
5 Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 165
GAP Publications . . . . . . . . . . . . . . . . . . . . . . . . . . 171
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 181
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Introduction
Human beings reflect, in a complex set of everyday
behaviors, the fact that they are repositories of a myriad of biological,
social, psychological, and cultural influences. In the medical field, the
doctor–patient relationship follows cultural rules as much as does the
patient’s attitude toward taking pills or undergoing procedures. The health
care delivery system of the United States also faces the growth, as well as
the economic and cultural needs, of ethnic minority groups in various
parts of the country. Many professional organizations in mental health
have acknowledged this reality and have provided practical tools for
improving clinical services to these groups. Hence, in this volume is
proposed a contemporary pragmatic understanding of how culture inter-
twines with and relates to mental health and mental illness. We offer this
by considering specific cultural variables and applying DSM-IV-TR (Amer-
ican Psychiatric Association 2000) guidelines for use of the cultural formu-
lation in a series of clinical case examples.
The first chapter presents a brief historical perspective of cultural
psychiatry over the last several decades and defines five essential dimen-
sions of cultural psychiatry as a clinical endeavor.
The second chapter includes a succinct but thorough description of
the main cultural variables influencing clinical work. This list of variables,
by no means exhaustive, emphasizes their conceptual connections and
clinical relevance to the five essential dimensions of cultural psychiatry.
The complexity of these variables—from gender, sexual orientation, and
age to religious/spiritual beliefs, myths, traditions, folklore, and dietary
habits and patterns—becomes greater as we move to consideration of so-
cioeconomic status, cultural identity, country of origin, education, and
vii
viii Cultural Assessment in Clinical Psychiatry
language. The final set of variables involves racial and ethnic factors that,
when taken together with the other elements, highlight the unique per-
sonal identity of each individual patient. The discussion of each variable
centers on its roles and functions, both positive and negative, as they re-
late to health and illness behavior, expression of symptoms, explanatory
models, stress causation, and social systems. Ultimately, each variable af-
fects diagnosis and treatment outcomes.
The third chapter is a historical account and a detailed analysis of the
cultural formulation presented in DSM-IV-TR (American Psychiatric Asso-
ciation 2000, Appendix I), the newest instrument for the thorough clinical
assessment of any patient who comes to the professional’s attention.
Practical examples, as well as an analysis of the items included in each
of the four specific areas of the cultural formulation, provide the reader
with a useful tool for the cultural assessment of a variety of clinical
events.
Perhaps the most important aspect of the book is the presentation in
the fourth chapter of five cases reflecting a wide variety of clinical situa-
tions and the role of cultural factors in their causation, course, manage-
ment, and outcome. These cases explore the previously mentioned
cultural variables and follow the structure outlined by the American Psy-
chiatric Association Practice Guidelines for Psychiatric Evaluation of
Adults (American Psychiatric Association 1995). There is special emphasis
on the application of the tenets of the cultural formulation appearing in
DSM-IV (American Psychiatric Association 1994) and DSM-IV-TR. A per-
tinent literature review, as well as comments by the authors based on
their specific expertise and clinical interests, completes each clinical
discussion.
The fifth and final chapter summarizes the contributions made in pre-
vious sections and outlines conclusions and suggestions regarding the
various issues raised by a thorough cultural assessment process in clinical
psychiatry. The Group for the Advancement of Psychiatry (GAP) Commit-
tee on Cultural Psychiatry believes that this book meets a significant need
of many psychiatrists and other mental health professionals committed to
giving their patients the most comprehensive and qualitatively useful care
possible. A solid cultural approach provides a valuable anchor for this
process.
Introduction ix
■ References
American Psychiatric Association: Diagnostic and Statistical Manual of
Mental Disorders, 4th Edition. Washington, DC, American Psychiatric
Association, 1994
American Psychiatric Association: Practice Guidelines for Psychiatric Eval-
uation of Adults. Washington, DC, American Psychiatric Association,
1995
American Psychiatric Association: Diagnostic and Statistical Manual of
Mental Disorders, 4th Edition, Text Revision. Washington, DC, Amer-
ican Psychiatric Association, 2000