Themes in cultural competence: Ritual cleansing and medicine noncompliance

Abstract

Introduction:

Psychiatry in westernized cultures focuses on biologic bases of illnesses and associated psychopharmacologic interventions. Frequently, cultural themes are not addressed. Positive clinical outcome requires trust and compliance which may not be present if clinicians are unaware of specific cultural beliefs and practices. Maximal clinical outcome involves integration of biologic interventions with patient's culture such that patient and patient's family experience being understood and respected regarding cultural differences that may impact recommended treatment. In this case, unawareness of patient's culture led to medicine noncompliance in a high risk patient.

Method:

Case analysis with literature review.

Results:

17-year-old single African-American female of Nigerian/Yoruba heritage with prior psychiatric admissions for Asperger's disorder with Psychotic Disorder NOS and suicidal ideation was stabilized on aripiprazole. Maternal aunt recommended ritual cleansing to assist with treatment. The mother believed that the attending psychiatrist could not understand/support this cultural/religious intervention, and felt cleansing would be best supervised in Nigeria. Unaware of the actual reason for the trip to Nigeria, the psychiatrist emphasized need for medicine compliance without reference to integrative care. The 5-day ritual cleansing, known as spiritual deliverance, consisted of fasting, prayers, and discontinuation of aripiprazole. Upon cleansing completion, patient resumed psychotropics; later, believing improvement was solely secondary to cleansing, she totally discontinued aripiprazole. Shortly thereafter, decompensation with paranoid/suicidal/homicidal ideations resulted in emergency hospitalization.

Conclusion:

Optimal clinical treatment requires integration of biologic interventions, psychotherapy, and patient's culture/religion. Unawareness of culture/religion can lead to medicine noncompliance and unnecessary decompensation.