Chapter 40. Cultural Issues

Albert C. Gaw, M.D.
DOI: 10.1176/appi.books.9781585623402.318666



Culture is important for psychiatric diagnosis and treatment because it provides the context in which patients interpret their experiences and imbue them with meanings. Culture constructs the psychiatric experience of the individual, provides the template for an individual's idiosyncratic interpretation of mental phenomena, and shapes their unique expression in each individual's setting. Thus, culture defines for the patient the intrinsic meaning of the illness experience, helping him or her to make sense out of what is usually a chaotic situation. Because each individual could be considered an epitome of his or her cultural product and achievement, and because culture varies from place to place, the presentation of mental symptoms may vary among individuals and across cultural groups.

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FIGURE 40–1. Proposed decision tree for culture-bound syndromes (CBSs) in DSM-IV.Source. Reprinted from Gaw AC: Concise Guide to Cross-Cultural Psychiatry. Washington, DC, American Psychiatric Publishing, 2001, p. 92. Copyright 2001, American Psychiatric Publishing. Used with permission.
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TABLE 40–1. Essential features of culture
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TABLE 40–2. DSM-IV-TR outline for cultural formulation
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TABLE 40–3. Key sociocultural factors contributing to nonadherence to psychotropic medications
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TABLE 40–4. Clinician's inquiry into the meanings of taking psychotropic medication
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Culture aids psychiatric diagnosis and treatment by providing a context to understand a patient's distress and its symbolic meanings.

Culture is a set of standards for behavior that a group or individual uses to orient him- or herself and that guides a person's behavior in all social circumstances, including illness behavior.

Components of culture include percepts, concepts, propositions, beliefs, values, and operational procedures (recipes).

Essential features of culture include the following:

– It is learned.

– It refers to systems of meanings.

– It acts as a shaping template.

– It is taught and reproduced.

– It exists in a constant state of change.

– It includes patterns of both subjective and objective elements of human behavior.

DSM-IV-TR's cultural formulation is a tool to elicit pertinent cultural data in the clinical encounter.

Culture-bound syndromes are recurrent, locality-specific patterns of aberrant behavior and troubling experiences that are indigenously considered to be "illnesses," or at least afflictions. They are generally limited to specific societies or culture areas.

Most culture-bound syndromes could be included in the "disorders not otherwise specified" in each of the relevant DSM-IV-TR diagnostic categories.

Sociocultural factors that may influence drug prescribing and the taking of drugs include (but are not limited to) physician biases, patient beliefs and expectations, placebo effects, cost and availability of medications, family support, and patient adherence or nonadherence to medications.

Sociocultural factors in psychotropic drug nonadherence are less well studied than biological factors, but they exert powerful influences on drug nonadherence.

The phenomenon of psychotropic drug nonadherence could be understood. The contributing factors of nonadherence should be as rigorously addressed as other challenging clinical problems.

Psychotherapy conducted across diverse cultures can be exciting, but it also is more demanding, because it requires knowledge and sensitivity to local cultural norms.


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Culture is a complex construct that is perhaps best understood through examination of a series of related components. The definition "an impression in the mind of something perceived by the senses, viewed as the basic component in the formation of concepts" refers to which of the following components of culture?
Which of the following statements regarding culture is false?
Cultural descriptions of episodic psychiatric illness include many syndromes in which dissociative fugue is a likely component. Which of the following syndromes is not thought to involve dissociative fugue?
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