16 - Culture in child and adolescent psychiatry

Summary

Summary Almost everyone continues to develop throughout life, but at no time is development more marked than in childhood and adolescence. Culture can influence this process in many ways and mental health clinicians and researchers need to be aware of this. Everyone has some sort of family, and definitions and compositions of families are changing all the time. Children are dependent on families in many ways so the family structure needs to be taken very much into account. A third area, apart from culture and family, that must be considered is the potential cultural mismatch between young people and their carers, which may affect presentations to mental health services. The relationship between culture and mental illness has been discussed elsewhere in this volume, so here I focus on the impact of culture on the practice of child and adolescent psychiatry and the context in which this psychiatric specialty is practised.

There are many definitions of culture, but for reasons discussed in chapter 27 and elsewhere (Dogra et al, 2007a) I use here that of the Association of American Medical Colleges (AAMC):

Culture is defined by each person in relationship to the group or groups with whom he or she identifies. An individual's cultural identity may be based on heritage as well as individual circumstances and personal choice. Cultural identity may be affected by such factors as race, ethnicity, age, language, country of origin, acculturation, sexual orientation, gender, socioeconomic status, religious/spiritual beliefs, physical abilities, occupation, among others. These factors may impact behaviours such as communication styles, diet preferences, health beliefs, family roles, lifestyle, rituals and decision-making processes. All of these beliefs and practices, in turn can influence how patients and heath care professionals perceive health and illness, and how they interact with one another. (Task Force on Spirituality, Cultural Issues, and End of Life Care, 1999: p. 25.)

A key advantage of this definition for psychiatry is its patient-centred nature: it allows patients to define which aspects of their whole are important to them and when. Although children can and do make choices about some of the aspects outlined above, they often find that choices are made for them without their involvement. There can be great pressure on children to behave in accordance with the most obvious aspect of themselves such as their ‘ethnic’ or ‘cultural’ background even if that is not how they feel about themselves.