19 - Cross-cultural psychiatric assessment

Summary

Summary Cultures affect the presentation of psychiatric symptoms, how and where help is sought, and also influence therapeutic engagement. Patients are generally interested in their illness, whereas clinicians are interested in dealing with the disease that patients present with. When assessing patients from other cultures, the clinician must be open-minded and explore symptoms in a culturally sensitive way. This includes a basic awareness of cultural norms and mores, and if the clinician is not aware of these, suitable sources of information must be explored. In this chapter we describe basic principles of assessment and outline good practice points.

Different cultures vary in their perceptions of mental illness (Karno & Edgerton, 1969), which can affect their utilisation of orthodox psychiatric facilities (Padilla et al, 1975; Sue, 1977). Mental health services may be seen by people from minority ethnic groups as challenging the value of traditional support systems, reflecting dominant Western cultural values and harbouring implicitly racist psychological formulations. The clinician– patient interaction may become fraught with misunderstandings if the two parties come from different cultural backgrounds and bring distinct cultural expectations to the encounter.

The concept of a core disease process with concentric rings of illness behaviour is a useful one, allowing the clinician to make sense of a diversity of surface phenomena which may all be related to a narrower range of disease categories. Thus, while the patient suffers from an ‘illness’, the clinician diagnoses and treats a ‘disease’ (Eisenberg, 1977; Kleinman, 1980). Yet classifications of illness vary across cultures, and individuals often carry such categories with them and use them to make sense of altered functioning. The clinician must identify whether a specific cluster of symptoms, signs and behavioural changes that are demonstrated by the patient are also interpreted consistently by them and their relatives, and how their personalised diagnostic models fit in with the psychiatric models.

Culture and mental illness

Culture can influence mental illness by defining the normal and the abnormal, by implicating domains of aetiological factors, by influencing the clinical presentation and by determining help-seeking behaviour.