What is culturally informed psychiatry? Cultural understanding and withdrawal in the clinical encounter

Leseth, Anne

doi:10.1192/pb.bp.114.047936

Cited by 9 publications

(7 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In fact, this ACSE dimension is the one that most pertains to the wider domain of empathic understanding, and not surprisingly it recalls the feelings of estrangement reported in some clinical vignettes [47] and in the studies about multilingual psychotherapeutic settings [57]. Further, it seems to be close to the notion of clinician’s uncertain attunement claimed by some scholars as a potential consequence of the ethnocultural diversity [39, 58, 68]. Hence, this result may contribute to the aforementioned debate about the clinician’s ability to sensitively feel the patient when the cultural diversity exacerbates the interpersonal otherness .…”

Section: Discussionmentioning

confidence: 62%

“…Indeed, the issues related to the cross-cultural assessment in psychiatric settings have been widely considered, especially concerning the different psychopathological manifestations across cultures and the related diagnostic uncertainties [35][36][37]. Many authors have suggested the necessity of a culturally informed psychiatry [38,39], able to deal with the clinician's biases in detecting, understanding, and treating mental illness in foreign patients [40][41][42][43][44], and substantial efforts were made to improve both diagnostic sensitivity and therapeutic intervention, especially through the development of the Cultural Formulation Interview [45,46].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Clinician’s Subjective Experience in the Cross-Cultural Psychiatric Encounter

Fonzi¹,

Picardi

Monaco

et al. 2020

Psychopathology

View full text Add to dashboard Cite

Introduction: The clinical encounter is still at the core of the psychiatric evaluation. Since the diagnostic process remains basically clinical in nature, several authors have addressed the complexity of the clinical reasoning process and highlighted the role played by intersubjective phenomena and clinician’s feelings. Some recent studies have supported the view of a significant link between the clinician’s subjective experience during the assessment and the diagnosis made. In a globalized world, this issue requires a careful reflection, since cultural differences may affect the intersubjective atmosphere of the encounter, which may indirectly influence the clinician’s thinking. Methods: We used a previously validated instrument, named Assessment of Clinician’s Subjective Experience (ACSE), to compare the clinician’s subjective experience during the evaluation of Italian patients with the subjective experience of the same clinician during the assessment of foreign patients. The 2 patient groups (n = 42 each) were individually matched for known potential confounders (age, sex, categorical diagnosis, and clinical severity). Results: We found no significant differences in mean scores on all ACSE dimensions (tension, difficulty in attunement, engagement, disconfirmation, and impotence), which suggests that cultural diversity did not substantially affect the clinician’s subjective experience. However, the lack of information about the native country and linguistic proficiency of about a quarter of foreign patients may have limited the possibility to detect subtle or specific differences, especially with regard to the clinician’s empathic attunement. Conclusions: Although further investigation is needed, our preliminary findings may have significant implications for the reflection upon the clinician’s empathic experience as well as pragmatic consequences for the act of psychiatric diagnosis in the cross-cultural encounter.

show abstract

Section: Discussionmentioning

confidence: 62%

Section: Introductionmentioning

confidence: 99%

Clinician’s Subjective Experience in the Cross-Cultural Psychiatric Encounter

Fonzi¹,

Picardi

Monaco

et al. 2020

Psychopathology

View full text Add to dashboard Cite

show abstract

“…The emic-etic perspective allowed us to discuss different kinds of knowledge and complementary data central to our investigation – for example, healthcare-seeking behaviours, understanding the sense of life from a Fang perspective following Simons D et al [ 41 ] through an objective, outsider perspective (etic) following Ruanoa. L. et al [ 42 ] and Leseth A.B [ 43 ], and from the participants’ point of view (emic). Data collection was conducted using two qualitative methods: semi-structured interviews and participant observation.…”

Section: Methodsmentioning

confidence: 99%

Exploring the knowledge, explanatory models of illness, and patterns of healthcare-seeking behaviour of Fang culture-bound syndromes in Equatorial Guinea

et al. 2018

View full text Add to dashboard Cite

In 1994, the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) included “culture-bound syndromes” in its classification of psychiatric disorders and associated them with disease processes that manifest in behavioural or thought disorders that develop within a given cultural context. This study examines the definitions, explanatory models, signs and symptoms, and healthcare-seeking behaviours common to Fang culture-bound syndromes (i.e., kong, eluma, witchcraft, mibili, mikug, and nsamadalu). The Fang ethnic group is the majority ethnic group in Equatorial Guinea. From September 2012 to January 2013, 45 key Fang informants were selected, including community leaders, tribal elders, healthcare workers, traditional healers, and non-Catholic pastors in 39 of 724 Fang tribal villages in 6 of 13 districts in the mainland region of Equatorial Guinea. An ethnographic approach with an emic-etic perspective was employed. Data were collected using semi-structured interviews, participant observation and a questionnaire that included DHS6 key indicators. Interviews were designed based on the Cultural Formulation form in the DSM-5 and explored the definition of Fang cultural syndromes, symptoms, cultural perceptions of cause, and current help-seeking. Participants defined “Fang culture-bound syndromes" as those diseases that cannot be cured, treated, or diagnosed by science. Such syndromes present with the same signs and symptoms as diseases identified by Western medicine. However, they arise because of the actions of enemies, because of the actions of spirits or ancestors, as punishments for disregarding the law of God, because of the violation of sexual or dietary taboos, or because of the violation of a Fang rite of passage, the dzas, which is celebrated at birth. Six Fang culture-bound syndromes were included in the study: 1) Eluma, a disease that is targeted at the victim out of envy and starts out with sharp, intense, focussed pain and aggressiveness; 2) Witchcraft, characterized by isolation from the outside, socially maladaptive behaviour, and the use of hallucinogenic substances; 3) Kong, which is common among the wealthy class and manifests as a disconnection from the environment and a lack of vital energy; 4) Mibili, a possession by evil spirits that manifests through visual and auditory hallucinations; 5) Mikug, which appears after a person has had contact with human bones in a ritual; and 6) Nsamadalu, which emerges after a traumatic process caused by violating traditions through having sexual relations with one’s sister or brother. The therapeutic resources of choice for addressing Fang culture-bound syndromes were traditional Fang medicine and the religious practices of the Bethany and Pentecostal churches, among others. Among African ethnic groups, symbolism, the weight of tradition, and the principle of chance in health and disease are underlying factors in the presentation of certain diseases, which in ethno-psychiatry are now referred to as culture-bound syndromes. In this study, traditional heal...

show abstract

“…Elements of culture affect beliefs on health care, coping and help seeking, mental illness, and wellness and health services (SAMHSA, 2014a); therefore, implementing culture-informed care with an individual refugee in treatment must involve providers’ efforts to (a) learn about refugees’ native culture; (b) learn the meaning and expressions of the symptoms in the native culture; (c) learn how they translate to diagnosing and treating; and (d) establish an acceptable way of communication with each patient and resilience for recovery (Kortmann, 2010). The demand for culture-informed care is especially increasing in the two top tiers of the MHPSS for clinical treatment of mental disorders or illness for better treatment responses, compliance, and sustained recovery (Kirmayer, Groleau, Guzder, Blake, & Jarvis, 2003; Leseth, 2015). To increase positive outcomes and quality of psychosocial programs and mental health services, the two-pillar approach should be further promoted, while reinforcing the existing competencies in each setting.…”

Section: A Two-pillar Approach: Trauma-informed and Culture-informed ...mentioning

confidence: 99%

A multitier model of refugee mental health and psychosocial support in resettlement: Toward trauma-informed and culture-informed systems of care.

Im¹,

Rodriguez²,

Grumbine

2021

Psychological Services

View full text Add to dashboard Cite

Refugees endure tremendous trauma during migration and resettlement. Despite the wide range of needs and challenges refugees have, previous research on refugee mental health has concentrated on the clinical treatment of certain common mental disorders related to premigration trauma. This narrow attention creates an environment in which positive mental health and social functioning are seen merely as a lack of mental illness among refugee populations. The consequences of such a focus are increased stigma of mental health issues and a negligence of other psychosocial needs critical to the community integration of refugee newcomers. There are few models and studies that focus on service delivery and systematic approaches to guide coordination of mental health services and psychosocial supports for refugee newcomers. To fill such gaps, this paper provides a framework to align stratified interventions and addresses the multilayered mental health needs in refugee communities. We have adopted and applied a multitier mental health and psychosocial support (MHPSS) model developed by the Inter-Agency Standing Committee to provide a holistic framework for a system of care. We have also proposed a two-pillar approach, trauma-informed and culture-informed care, which is embedded into each tier of the MHPSS program. This approach is designed to fill the gaps between mainstream mental health services and refugee resettlement programs, both of which tend to work in silos. Using the case of a statewide refugee mental health initiative in Virginia, we discuss the challenges and opportunities of programs to build capacity and partnerships for coordinated care.

show abstract

What is culturally informed psychiatry? Cultural understanding and withdrawal in the clinical encounter

Cited by 9 publications

References 21 publications

Clinician’s Subjective Experience in the Cross-Cultural Psychiatric Encounter

Clinician’s Subjective Experience in the Cross-Cultural Psychiatric Encounter

Exploring the knowledge, explanatory models of illness, and patterns of healthcare-seeking behaviour of Fang culture-bound syndromes in Equatorial Guinea

A multitier model of refugee mental health and psychosocial support in resettlement: Toward trauma-informed and culture-informed systems of care.

Contact Info

Product

Resources

About