Transcultural Psychiatry

By Engelsmann, Frank Frantisek | Canadian Journal of Psychiatry, April 2005 | Go to article overview
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Transcultural Psychiatry

Engelsmann, Frank Frantisek, Canadian Journal of Psychiatry

Transcultural Psychiatry Clinician's Guide to Cultural Psychiatry. Wen-Shing Tseng. Amsterdam: Academic Press; 2003. 493 p. US$59.95.

Reviewer rating: Very Good

This didactic, detailed, and practical guide to cultural psychiatry is a remarkable contribution, enhancing culture-oriented clinical assessment and care. The text is an updated clinical elaboration of Tseng's comprehensive Handbook of Cultural Psychiatry, published by Academic Press in 2001. There is a great need for culturally competent clinical care of the many ethnic groups in this time of global economy, large population movements, and increased international contacts.

Wen-Shing Tseng, professor of psychiatry at the University of Hawaii, was well prepared for his demanding task. He obtained training in psychiatry at the National Taiwan University and later at Harvard Medical School in Boston. As a consultant to the WHO for teaching and research projects, he visited many countries in Asia and the Pacific and conducted studies related to culture and psychopathology, family relations, folk healing, and psychotherapy. He has numerous scholarly publications.

The introductory chapters describe basic concepts of culture and its impact on the mind, on behaviour, and on psychopathology, with a focus on stress, illness reactions, and coping methods. Culture refers to the unique behaviour patterns and lifestyle shared by a group characterized by a set of values, attitudes, and beliefs. Race is a socially and culturally constructed category that may have little to do with actual biological differences. The author argues that the validity of race as a biological term has been discredited (p 7). Although it is difficult to generalize about national character traits in large societies composed of numerous ethnic groups and subcultures, the author mentions some characteristics of the American, Japanese, Russian, and Chinese personality (p 29-32).

The author analyzes the stress-related impact of culturally formed anxiety, culturally demanding performance, limitations of expression, sociocultural discrimination, and cultural uprooting or destruction. He presents concepts of traditional Chinese, Ayurvedic, and Galenic-Islamic medicine and discusses the distinction between illness and disease, the sick role, help-seeking behaviour, service use, and compliance. The core of the book deals with culture and psychopathology, presenting cultural aspects of anxiety disorders, cultural contribution to causes of depression, dissociative states, somatoform disorders, substance abuse, and suicidal behaviour. The author examines culture's influence on the clinical manifestations and prognosis of schizophrenia and personality disorders. Cross-cultural information about personality disorders is limited and needs more investigation (p 199). The contribution of culture to psychopathology can occur in the form of pathoselective, pathoelaborating, and pathofacilitative effects, but the application of these innovative concepts needs more testing.

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