Cultural Psychiatry

R. D. Alarcón, R.D., Alarcón, T. N. Wise, T.N., Wise

• Publisher: S. Karger
• Year: 2013
• Print ISBN: 9783318023947
• eBook ISBN: 9783318023954
• Topic: Medicine
• Subtopic: Medical Education

Cultural Psychiatry with emphasis on its impact on etio-pathogenesis, diagnosis, clinical practice, preventive and research activities are topics discussed in this publication which give readers a general conceptual perspective of this field. Cultural aspects of psychiatric diagnosis in DSM-5 in particular and the current status of Cultural Psychiatry in European countries are discussed. Of unique importance to the field of psychosomatics are the reviews on so-called culture-bound syndromes and somatization and culture. Ethnopsychopharmacology, pharmacogenomics, current and future research perspectives in Cultural Psychiatry and bioethical dimensions of cultural psychosomatics are also reviewed. The volume closes with an epilogue and conclusions resulting from the examined topics. Psychiatrists, psychologists, social scientists and other mental health professionals involved in clinical practice and research groups as well as trainees and students will find that this publication provides a cogent perspective of current practice and research issues about a field that has enormous clinical relevance and which, until recently, has been systematically neglected.

Alarcón RD (ed): Cultural Psychiatry.
Adv Psychosom Med. Basel, Karger, 2013, vol 33, pp 97–114 (DOI: 10.1159/000348742)

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Cultural Psychiatry: Research Strategies and Future Directions

Laurence J. Kirmayer^a · Lauren Ban^b

^aDivision of Social and Transcultural Psychiatry, McGill University, Montreal, Que, Canada; ^bUniversity of Melbourne, Melbourne, Vic., Australia

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Abstract

This chapter reviews some key aspects of current research in cultural psychiatry and explores future prospects. The first section discusses the multiple meanings of culture in the contemporary world and their relevance for understanding mental health and illness. The next section considers methodological strategies for unpacking the concept of culture and studying the impact of cultural variables, processes and contexts. Multiple methods are needed to address the many different components or dimensions of cultural identity and experience that constitute local worlds, ways of life or systems of knowledge. Quantitative and observational methods of clinical epidemiology and experimental science as well as qualitative ethnographic methods are needed to capture crucial aspects of culture as systems of meaning and practice. Emerging issues in cultural psychiatric research include: cultural variations in illness experience and expression; the situated nature of cognition and emotion; cultural configurations of self and personhood; concepts of mental disorder and mental health literacy; and the prospect of ecosocial models of health and culturally based interventions. The conclusion considers the implications of the emerging perspectives from cultural neuroscience for psychiatric theory and practice.

Copyright © 2013 S. Karger AG, Basel

Cultural psychiatry is concerned with the ways in which psychopathology and healing are shaped by cultural knowledge and practices. Cultural differences between individuals and groups are associated with differences in illness behavior and experience. Recognizing these differences is important to provide equitable and appropriate health care [1] but it also can reveal underlying processes that contribute to mental health and illness [2]. All experience emerges from personal developmental histories and life situations that reflect specific cultural contexts. Understanding the interaction of culture, psychology and biology over time is central to the integrative vision of the biopsychosocial approach.

There is a long association between cultural psychiatry and psychosomatic medicine. This stems in part from the recognition that, across cultures, mental and physical health are closely interrelated if not inseparable. Indeed, the very distinction between mind and body that gives rise to the central conceptual problem of psychosomatic medicine is a consequence of a dualistic ontology that has a long cultural history in Western philosophy and medicine [3]. The fact that this dualism persists in everyday clinical thinking, despite efforts to articulate more integrative and holistic theories, reflects our basic cultural concepts of the person [4].

The ways that culture is conceptualized influence research questions and methodologies. In early psychological and psychiatric research, the term culture was taken as synonymous with ethnocultural group. Later studies began to ‘unpack’ the notion of culture, defining it in terms of the values, beliefs, and practices associated with an ethnocultural group [5]. This operational definition of culture in terms of traits or aspects allowed researchers to begin to explore how culture influences the manifestations and perceptions of and responses to mental disorder. Attention to specific individual manifestations of culture reveal the heterogeneity among group members, in which some people but not others adhered to certain cultural values and practices.

Thinking about Culture and Mental Health

Culture is not simply the aggregate of individual traits but a more or less coherent system of shared meanings, institutions and practices (i.e. beliefs, attitudes and values) [6-8]. According to this view, culture is a repository of meaningful symbols that structure experience both implicitly and through explicit models. These models are deployed through active processes of signification, meaning-making and self-fashioning by specific actors in concrete situations. Whereas the systems view takes culture to consist of a relatively stable set of knowledge, skills and representations carried by individuals and used across diverse social contexts, the process view insists that culture is not just ‘in the head’ but ‘in the world’, embodied in institutions, artefacts, technologies, protocols and practices. A focus on process reveals that culture is often fragmented, fluid and context-specific [9-10]. Social structures and enduring systems of meaning emerge from the actions of individuals in concrete situations.

The system- and practice-oriented views of culture are complementary and both are needed to characterize the impact of culture on mental health. The two perspectives can be integrated in a cultural dynamic view that recognizes that culture endures as well as changes, that culture is both context-general and locally situated, and that individuals’ meaning-making activities in specific situations generate collective patterns of meaning that can be interpreted as a globally enduring system [11]. The cultural dynamic view encourages researchers to study how culture and psyche ‘make each other up’ in processes of mutual constitution. This view allows us to shift from the trait view where culture is treated a cause or independent variable in quasi-experimental designs.

Cultural diversity is an expression of human creativity and reflects our capacity to adapt to diverse ecological niches by adopting different patterns of subsistence and social organization. In terms of individual and social function, culture is the software of the mind, transmitted through interpersonal interaction and participation in social practices and institutions. The brain is the organ of culture, the hardware which cultural experience programs by modifying its microarchitecture, and the long period of neuroplasticity that characterizes human brain development occurs precisely to allow the acquisition of complex cultural knowledge, skills and patterns of habitual behavior [12].

Furthermore, culture produces a variety of identities tied to specific aspects of social life including language, religion, ethnicity, or racialized groups. The significance of these culturally constructed categories for health and illness depends crucially on their social meaning. For example, racial identity in the US is a cultural construction that reflects the history of slavery and current structural forces that maintain systems of demarcation, discrimination and disadvantage [13]. Hence, observed biological effects of race on health, like the increased frequency of high blood pressure among African Americans, can be understood not as a direct consequence of some genetic difference associated with race or skin color, but as a consequence of the social stresses that individuals experience as a result of being labeled ‘Black’ [14].

Unpacking the received categories of culture, race and ethnicity to go beyond stereotypes requires care in how we use existing labels. Research needs to follow a series of steps to: (1) define cultural groups or contexts with a high degree of detail and specificity; (2) consider what social processes give rise to these definitions; (3) identify specific social/cultural parameters relevant to particular outcomes; (4) attend to individual variation within cultural groups; and (5) consider the cultural assumptions of research theory, hypothesis and design.

The aspects of culture, ethnicity and race that are especially important to psychiatry are those associated with significant differences in mental health, because they involve different exposures to social determinants of health or shape the ways that people adapt to illness, through coping, help-seeking and treatment response. In general, understanding the significance of culture for mental health and illness requires identifying specific knowledge, practices, values, ways of thinking or social positions and predicaments that interact with the mechanisms of psychopathology and adaptation or recovery. For example, the observed high rates of schizophrenia and other psychotic disorders among African-Caribbean migrants to the UK may reflect social adversity and structural violence associated with racism and discrimination [15]. The negative impact of migration can be partially mitigated by living in a neighborhood with people from the same background [16]. This impact of ethnic density can only be understood by linking social processes at the level of urban neighborhoods with psychophysiological processes transduce the everyday challenges of negotiating friendly or hostile social environments into bodily and psychological well-being or stressful wear and tear [17].

The notions of ethnicity, race and culture have undergone constant transformation with changes in migration, ideologies of citizenship and national identity, and new technologies. Over time, new hybrid forms of identity emerge and groups define and assert themselves as distinct communities, introducing new actors and positions into the social world. These are not only new categories or identities but new ways of experiencing belonging and creating communities bound together by ways of life.

While the forces of globalization – including greater mobility, economic exchange and exploitation – have increased cultural homogeneity, they have also allowed the emergence of new hybrid forms of culture [18, 19]. Hence, there is no reason to believe that we will arrive at a global monoculture any time soon. Instead, we are likely to face a complex interplay between larger cultural blocs and a great diversity of smaller cultural groups maintained through networking and electronic media that allow connections and maintain communities despite distance and dispersion.

Methodological Strategies in Cross-Cultural Research

Cultural psychiatry presents unique epistemological, methodological and con...

Table of contents

• Cover Page
• Front Matter
• Cultural Psychiatry: A General Perspective
• Culture and Psychiatric Diagnosis
• Trends in Cultural Psychiatry in the United Kingdom
• Opening Up Mental Health Service Delivery to Cultural Diversity: Current Situation, Development and Examples from Three Northern European Countries
• Cultural Psychiatry in the French-Speaking World
• Transcultural Aspects of Somatic Symptoms in the Context of Depressive Disorders
• Culture and Demoralization in Psychotherapy
• Ethnopsychopharmacology and Pharmacogenomics
• Cultural Psychiatry: Research Strategies and Future Directions
• Bioethical Dimensions of Cultural Psychosomatics: The Need for an Ethical Research Approach
• Epilogue
• Author Index
• Subject Index