Culture and Psychiatric Education

acad.ro

Cultural competence tends to become more and more important for the clinical practice in many European countries where the recent migration flow has created bigger demographic, ethnic and cultural heterogeneity. Yet, it has been promoted especially in the countries that, already for several decades, have evolved also on the political plan, from monoculturalism to bi- or even multiculturalism, such as Australia, New Zeeland, Canada or USA. Situated in the larger context of globalization, of the economic development still unequal between North and South, of the various changes of the policies regarding the labour right in the EU Members, but also of the international armed conflict areas leading to forced migration towards zones that can provide basic surviving conditions, Romania participates to the same population flow in which immigration and emigration are more and more dynamic. It can be foreseen that both the economic migration and the forced one will create also in our country a much higher ratio of communities with different cultural and linguistic origins (CALD - Cultural and Linguistic Diversity). Under these circumstances, providing competent and efficient mental health services and equal access to medical services will involve the development of training programmes for health professionals in order to offer them the cultural knowledge, the abilities and skills necessary for communicating with patients from other cultures. In this regard, an essential role is played by the medical anthropology whose potential is still unexplored in our country. The purpose of this article is to present some debates in the scientific literature, dedicated to cultural competence and its role in the field of clinical psychiatric practice, with a special focus on some of our contributions to modelling a culturally competent approach in the case of patients suffering from various psychiatric disorders.

While mental illness has recently been framed in largely neurobiological terms as brain disease, there has also been an increasing awareness of the contingency of psychiatric diagnoses. In this course, we will draw upon readings from medical and psychological anthropology, cultural psychiatry, and science studies to examine this paradox and to examine mental health and illness as a set of subjective experiences, social processes and objects of knowledge and intervention. On a conceptual level, the course invites students to think through the complex relationships between categories of knowledge and clinical technologies (in this case, mainly psychiatric ones) and the subjectivities of persons living with mental illness. Put in slightly different terms, we will look at the multiple links between psychiatrists’ professional accounts of mental illness and patients' experiences of it. Questions explored include: Does mental illness vary across social and cultural settings? How are experiences of people suffering from mental illness shaped by psychiatry’s knowledge of their afflictions?

Advances in Psychiatric Treatment, 2004

We discuss the complicated nature of communication between people from different cultural groups, perhaps using a second language. We focus on the fact that mental health practitioners and service users often have in common neither their cultural backgrounds nor their explanatory models of illness. Communication even in a shared language can be less than optimal as words carry multiple meanings. Consequently, consultations that involve culturally grounded explanatory models of illness challenge the professional. We give examples showing that reconciling different explanatory models during the consultation is a core task for psychiatrists and mental health practitioners working in multicultural settings.

While mental illness has recently been framed in largely neurobiological terms as “brain disease,” there has also been an increasing awareness of the contingency of psychiatric diagnoses. In this course, we will draw upon readings from medical and psychological anthropology, cultural psychiatry, and science studies to examine this paradox and to examine mental health and illness as a set of subjective experiences, social processes and objects of knowledge and intervention. On a conceptual level, the course invites students to think through the complex relationships between categories of knowledge and clinical technologies (in this case, mainly psychiatric ones) and the subjectivities of persons living with mental illness. Put in slightly different terms, we will look at the multiple links between psychiatrists’ professional accounts of mental illness and patients' experiences of it. Questions explored include: Does mental illness vary across social and cultural settings? How are experiences of people suffering from mental illness shaped by psychiatry’s knowledge of their afflictions?

Mental Illnesses - Understanding, Prediction and Control, 2012

Why the study of culture and its clinical application is important in mental health training and service? Mental health and illness is a set of subjective experience and a social process and thus involves a practice of culture-congruent care. Series of anthropological, sociological and cross-cultural research has clearly demonstrated a very strong ground in favour of this contention. An individual's cultural background colours every facets of illness, from linguistic or

2010

The experience of distress and illness, let alone the utilisation of services, are not just phenomena of natural science manifest in an individual patient but patterns which interact with the patient's milieu, cultural values and the wider society, including the relationship between the doctor or other therapist and the patient, and with the doctor's own ethnicity, theoretical assumptions and the professional and political status of psychiatry itself.'' Littlewood (1991)

International Journal of Circumpolar Health, 2015

Background. The Sami in Norway have a legal right to receive health services adapted to Sami language and culture. This calls for a study of the significance of language choice and cultural norms in Sami patients' encounters with mental health services. Objectives. To explore the significance of language and cultural norms in communication about mental health topics experienced by Sami patients receiving mental health treatment to enhance our understanding of linguistic and cultural adaptation of health services. Method. Data were collected through individual interviews with 4 Sami patients receiving mental health treatment in Northern Norway. A systematic text reduction and a thematic analysis were employed. Findings. Two themes were identified: (I) Language choice is influenced by language competence, with whom one talks and what one talks about. Bilingualism was a resource and natural part of the participants' lives, but there were limited possibilities to speak Sami in encounters with health services. A professional working relationship was placed on an equal footing with the possibility to speak Sami. (II) Cultural norms influence what one talks about, in what way and to whom. However, norms could be bypassed, by talking about norm-regulated topics in Norwegian with health providers. Conclusion. Sami patients' language choice in different communication situations is influenced by a complexity of social and cultural factors. Sami patients have varying opinions about and preferences for what they can talk about, in which language, in what way and with whom. Bilingualism and knowledge about both Sami and Norwegian culture provide latitude and enhanced possibilities for both patients and the health services. The challenge for the health services is to allow for and safeguard such individual variations within the cultural framework of the patients.

Transcultural psychiatry, 2006

call creolization the meeting, interference, shock, harmonies and disharmonies between the cultures of the world. .. [it] has the following characteristics: the lightening speed of interaction among its elements; the awareness of awareness: thus provoked in us; the reevaluation of the various elements brought into contact (for creolization has no presupposed scale of values); unforeseeable results. Creolization is not a simple cross breeding that would produce easily anticipated results.' (Edouard Glissant, 1997) The practice of psychotherapy depends on a fund of tacit knowledge shared by patient and clinician (Frank, 1973). Intercultural work challenges this shared 'assumptive world' and poses problems of translation and positioning, working across and between systems of meaning and structures of power that underpin the therapeutic alliance and the process of change. The encounter of patient and clinician from two different cultures is not simply a matter of confrontation or exchange between static systems of beliefs and values. Once viewed as self-contained worlds of meaning, cultures are now seen as systems of knowledge and practicesustained by cognitive models, interpersonal interactions, and social institutions-that provide individuals with conceptual tools for selfunderstanding and rhetorical possibilities for self-presentation and social positioning. Moreover, cultural worlds are open-systems, shaped by forces of migration, globalization, and hybridization (Hannerz, 1996; Papastergiadis, 2000). This flux destabilizes old values, identities and ways of life