Culture in Psychiatric Care

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Culture in Psychiatric Care

• Albert C. Gaw, M.D., D.F.A.P.A.
• Clinical Professor of Psychiatry
• University of California
• San Francisco

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Purposes of Presentation

• To provide a clinically useful definition of
  culture
• To draw implications for mental health care

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Culture

• A set of standard for behavior which a group of
  people attribute to those around them and which
  they used to orient their own behavior

Goodenough
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Culture

• Ideas that people carry around in their heads
  about how other people, significant other people
  in their environment should act, standards that
  they attribute to others around them and which
  they used to guide their own behavior.

A. Harwood
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DSM-IV Definition

• Meanings, values, and behavioral norms that are
  learned and transmitted in the dominant society
  and within its social groups. Culture powerfully
  influences cognitions, feelings, and the self
  concept, as well as the diagnostic process and
  treatment decisions.

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Race

• A number of broad divisions of the human species,
  based on a common geographic origin, certain
  shared physical characteristics and distinguished
  from other such groups by a characteristic
  distribution of gene frequencies.

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Ethnicity

• Collectivity of people within a larger society
  defined on the basis of both common origins,
  shared symbols and standards for behavior.

Schermerhorn
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Essential Features of Culture

• Culture is learned
• Culture refers to systems of meanings
• Culture acts as a shaping template

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Essential Features of Culture

• Culture is taught and reproduced
• Culture exists in a constant state of change
• Culture includes patterns of both subjective and
  objective components of human behavior

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Components of Culture

• 1. Percepts and concepts
• Percept an impression in the mind of something
  perceived by the senses, viewed as the basic
  component in the formation of concepts.

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Association Areas of the Brain
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Components of Culture

• Concept a general idea or understanding
  especially one derived from specific instances or
  occurrences.
• A thought or notion
• E.g. anxiety, depression, schizophrenia

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Korean Concept
Luke Kim 1993
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Hwa-byung
Luke Kim 1993
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Components of Culture

• 2. Proposition ways in which percepts and
  concepts can be related to one another.
• Location
• Part/whole
• Causal

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Components of Culture

• 3. Beliefs Propositions considered to be true.
• The world is round
• God is almighty

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Components of Culture

• 4. Values Ways in which the world is organized
  into hierarchy of preferences.
• Life gt death
• Health gt illness

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Components of Culture

• 5. Operational procedures or recipe ways in
  which people organized their effort to accomplish
  certain purposes.
• Taking a psychiatric history
• Mental Status examination
• ECT

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In Summary

• Percepts and concepts
• Propositions
• Beliefs
• Values
• Operational Procedures or
• Recipes

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Culture vs. Subculture

• Culture involves very broad guideline or
  standards governing behavior in a wide variety of
  context, from cradle to grave.
• Subculture narrower sets of standards which
  govern how one acts in a smaller range of
  behavior with a particular set of actors.

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Operating Culture

• Standards a person used at a particular time with
  significant others.

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Implications for Mental Health Care

• It enhances diagnosis and treatment.
• It fosters clinicians sensitivity towards
  patients/clients.
• It enriches psychiatric knowledge.

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Implications for Mental Health Care

• It provides guidelines for judgment of
  normality versus abnormality of behavior.
• It provides a proper understanding of human
  beings, whether their behavior is normative or
  deviant.

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Reference

• Gaw AC Concise Guide to Cross-Cultural
  Psychiatry. American Psychiatric Publishing,
  Inc., Washington, DC, 2001

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Thank you !