The Implication of Transcultural Psychiatry for Clinical Practice
Moldavsky, Daniel, The Israel Journal of Psychiatry and Related Sciences
Abstract: This article deals with the main concepts of Transcultural Psychiatry and their applications to everyday psychiatric practice. Transcultural psychiatry has undergone a conceptual reformulation in the last two decades. Having started with a comparative approach, which focused on the diverse manifestations of mental disorders among different societies, it broadened its scope, aiming at present to incorporate social and cultural aspects of illness into the clinical framework. Therefore, transcultural psychiatry now focuses more on what is called the illness experience than on the disease process, the latter understood as illness as it is viewed by health practitioners. Western medicine, of which psychiatry is a part, is grounded in positivist epistemological principles that stress the biological processes of disease. The intention of the paper is to develop an interest in alternative but also complementary ways of thinking. Modern transcultural psychiatry interprets some epidemiological and clinical aspects of major mental disorders (such as schizophrenia and depression) in a different light. However, it also distances itself from the absolute relativism of antipsychiatry, centering on clinical facts and helping clinicians in their primary task of alleviating suffering. An important contribution in addressing this task is the formulation of a cultural axis within the DSM model of multiaxial evaluation. A clinical vignette of a cultural formulation applied to a clinical discussion of a case is described.
The purpose of this article is to discuss subjects related to the field of cultural psychiatry, now commonly labeled "transcultural psychiatry" (TCP). I will try to illustrate how this approach deals with the interpretation of relevant epidemiological and clinical findings about several major mental disorders. Due to limitations of space, I cannot deal with all subjects related to TCP, or with all the mutual and rich relationships between psychiatry and human sciences. In our daily clinical work, we may not be fully aware of cultural or social aspects of illness. I would like to raise the possibility of rethinking our current praxis, or at least reminding ourselves of the totality of experience that patients and families bring to us.
Defining "culture" is not a simple task (1). Dictionaries contain about 200 different meanings of the word. For psychiatry, a medical discipline whose main goal is to alleviate human suffering caused by mental illness, culture has to be meaningful at a clinical level. Simply stated, culture is the water in which human beings swim during their lives. It is the sum total of systems and human creations that have symbolic value and shape the networks in which human interactions take place. The human body is made up of complex biological systems, but it is also culturally constructed through experiences with primary caretakers, which, in turn, reflect deeply rooted societal norms and cultural values.
Disease, which is conceptualized by Western medicine as a process that takes place primarily in the human body, has a natural history. The social history of disease has been considered less in daily clinical practice and even in theoretical discussions. It is clear, however, that disease can have different histories in different environments, depending on social, economic and cultural variables.
Even the most biologically oriented psychiatry diverges from other biomedical specialties in that diagnosis is formulated mainly by listening to a patient's narratives and interpreting behaviors, both of which are subsequently constructed as signs and symptoms of his or her mental state. Both narratives and interpretations can be culturally rooted and ideologically invested (2). At this point, it is worth thinking about how the consideration of social and cultural issues may enrich our practice of psychiatry.
The Construction of Psychiatric Knowledge
Psychiatric knowledge is constructed within a specific cultural milieu at a certain point in the history of science. …