1. TRANSCULTURAL PSYCHIATRY
Satyakam Mohapatra
Junior resident-III
Transcultural psychiatry

2. TRANSCULTURAL PSYCHIATRY & ITS
DEVELOPMENT
WHAT IS CULTURE ?
CULTURE AND PSYCHOPATHOLOGY
CULTURAL PSYCHODYNAMICS: CULTURAL
VARIABLES RELEVANT TO MENTAL ILLNESS
CULTURE AND PERSONALITY
CULTURAL CONSIDERATION IN CLINICAL
PRACTICE
FUTURE DIRECTIONS AND RESEARCH IN
TRANSCULTURAL PSYCHIATRY

3. CULTURE
•
Culture refers to the meanings, values and
behavioural norms that are learned and
transmitted in the dominant society and
within its social groups. Culture powerfully
influences cognition, feelings, and self
concept as well as the diagnostic process
and treatment decisions.
The National Institute of Mental Health’s Culture and
Diagnosis Group, 1993.

4. Culture has six essential components
(1) Culture is learned.
(2) Culture can be passed on from one generation to the next.
(3) Culture involves a set of meanings in which
words, behaviors, events, and symbols have meanings agreed
upon by the cultural group.
(4) Culture acts as a template to shape and orient future
behaviors and perspectives within and between generations
and to take account of novel situations encountered by the
group.
(5) Culture exists in a constant state of change.
(6) Culture includes patterns of both subjective and objective
components of human behavior

5. Culture shapes how and what psychiatric symptoms
are expressed.
 Culture influences the meanings that are given to
symptoms.
Culture also impacts the interaction between the
patient and the health care system.
CULTURE AND PSYCHIATRY

6. Study of cultural differences in psychopathology has progressed under a
number of names within psychiatry (e.g., transcultural psychiatry, cultural
psychiatry, ethnopsychiatry, cross-cultural psychiatry)
It is almost 100 years ago that the founder of modern psychiatry, Emil
Kraepelin, envisaged a new discipline of comparative psychiatry, focussed
on ethnic and cultural aspects of mental health and illness.
The term Transcultural Psychiatry was introduced by Eric Wittkower of
McGill University, Montreal. (1950 )
HISTORY OF TRANSCULTURAL PSYCHIATRY
Henry Murphy defined the principal objectives of the discipline: to
identify, verify and explain the links between mental disorder and the
broad psychosocial characteristics which differentiate nations, peoples
and cultures (1982)

7. “The discipline that deals with the
description, definition, assessment and management of
all psychiatric conditions as they reflect and are subjected
to the influence of cultural factors in a biopsychosocial
context while using concepts and instruments from social
and biological sciences to advance a full understanding of
psychopathology and its treatment”
TRANSCULTURAL PSYCHIATRY

8. CULTURE AND PSYCHOPATHOLOGY

9. Some Basic Questions in the Study of
Culture and Psychopathology
1. What is the role of cultural variables in the etiology
of psychopathology?
2. What are the cultural variations in standards of normality
and abnormality?
3. What are the cultural variations in the classification and
diagnosis of psychopathology?
4. What psychometric factors must be considered in the
assessment of psychopathology across cultures?
5.What are the cultural variations in the phenomenological
experience, manifestation, course and outcome of
psychopathology?
6. How do we design and offer culturally appropriate mental
health services ?

10. • Culture contributes to psychopathology in different ways.
• Generally speaking , psychopathology is predominantly
determined by biological factors is less influenced by cultural
factors and any such influence is secondary.
• In contrast, psychopathology that is predominantly
determined by psychological factors is attributed more to
cultural factors.
• This basic distinction is necessary in discussing different levels
of cultural impact on various types of psychopathologies.
CULTURE AND PSYCHOPATHOLOGY

11. CULTURE CAN CONTRIBUTE TO PSYCHOPATHOLOGY IN SIX
DIFFERENT WAYS (TSENG, 2001).
PATHOGENIC EFFECTS
PATHOSELECTIVE EFFECTS
PATHOELABORATIVE EFFECTS
PATHOPLASTIC EFFECT
PATHOFACILITATIVE EFFECTS
PATHOREACTIVE EFFECTS

12. • Pathogenic effects refer to situations in which
culture is a direct causative factor in forming
or ‘generating’ psychopathology.
• Cultural ideas and beliefs contribute to
stress, which in turn produces
psychopathology.
• Stress can be created by culturally formed
anxiety ,culturally demanded performance.
PATHOGENIC EFFECTS
(cultural influence on the formation of a disorder)

13. EXAMPLES:
• DHAT SYNDROME( In INDIA ‘Harmful’ leaking
of semen can produce anxiety , depression
and somatic symptoms.)
• KOROPANIC (the folk belief that death will
result if the penis shrinks into the abdomen.
Found in Malaysia )
• So culture is the direct cause of
psychopathology, not of disease per se.
PATHOGENIC EFFECTS (contd.)

14. • It is the tendency of some people in a society, when
encountering stress, to select certain culturally influenced
reaction patterns that result in the manifestation of certain
psychopathologies.
• FAMILY SUICIDE’ observed in Japanese society (Ohara,1963).
• In Japan, cultural influences lead a family encountering
serious stress or a hopeless situation to choose, from among
many alternative solutions, to commit suicide
together, forming the unique psychopathology.
PATHOSELECTIVE EFFECTS
(culture selecting certain coping patterns to deal with stress)

15. • Amok attack : In Malaysia man humiliated in public, following
cultural custom, lead to take a weapon and kill people
indiscriminately to show his manhood.
• Culture has a powerful influence on the choices people make in
reaction to stressful situations and shapes the nature of the
psychopathology that occurs as a result of those choices.
• Of course, this only applies to minor psychiatric
disorders, particularly of culture-related specific syndromes, not to
major psychiatric disorders.
PATHOSELECTIVE EFFECTS(Contd.)

16. • Pathoplastic effects refer to the ways in which
culture contributes to the modeling or ‘plastering’ of
the manifestations of psychopathology.
• Culture shapes symptom manifestations at the level
of the content presented.
• The content of delusions, auditory
hallucinations, obsessions, or phobias are subject to
the environmental context in which the pathology is
manifested.
PATHOPLASTIC EFFECT
(culture modifying the clinical manifestation)

17. PATHOPLASTIC EFFECTS AND SCHIZOPHRENIA:
Paranoid subtype as most common and over represented
in developed countries while Catatonic and Acute
subtypes in developing countries.
[(Murphy,1982),IPSS(WHO,1973)]
 Effect On symptomatology:
Schneider’s (1959) First Rank Symptoms (FRS ):
• The IPSS (WHO, 1973) have shown that patient with
schizophrenia from India and Africa differed from western
patients.
• Patients from Agra were shown to have less FRS and more
flatness of affect as compared to patients from Washington
(Carpenter and Strauss, 1974).
PATHOPLASTIC EFFECT(Contd.)

18. • Religious delusions and delusional guilt are primarily found in Christian
societies than Islamic, Hindus or Buddhist [Kala and Wig (1982), Kim et
al., 2001; Murphy (1967), Stompe et al (1999, 2006), Tateyama et al(1998)]
• Patients from developing countries also reported visual hallucinations
more frequently than those from developed countries while affective
symptoms were reported more from later (Varma et al., 1997)
• Depending on the intensity of the plastic effect and the degree of
modification of symptomatology, culture will affect the psychopathology
in such a way that the disorders could be recognized as ‘atypical’
,‘subtypes’, or ‘variations’ of disorders officially recognized in the current
Western classification system.
PATHOPLASTIC EFFECT(Contd.)

19. • While certain behaviour reactions (either normal or pathological) may be
universal, they may become exaggerated to the extreme in some cultures
through cultural reinforcement (Simon,1996).
• This is well illustrated by the phenomenon of “Trance and possession
state”. It is a culturally sanctioned, nearly institutionalized means for
experience for ego-dystonic impulses and thoughts, reported by various
authors.
(Teja et al., 1970; Varma, 1970)
• This could be described to the religious elaboration of association with
‘Atman’ and ‘Deities’ .
PATHOELABORATING EFFECTS(culture elaborating
mental conditions into a unique nature)

20. • In western countries and urban areas of developing countries
there is increasing concerned with body weight in relation to
health— due to cultural elaboration by many methods of diet
control and instruments for physical exercises.
• In addition to health-related concerns, the culture-shaped
body image belief that “slim is beautiful" may cause “body
weight anxiety.”
• Common reason for eating disorders in developed countries .
PATHOELABORATING EFFECTS(C0NTD.)

21. • Cultural factors do contribute significantly to the frequent
occurrence of certain mental disorders in a society.
• The disorder potentially exists and is recognized globally, yet, due to
cultural factors, it becomes prevalent in certain cultures at
particular times. Thus, ‘facilitating’ effects make it easier for certain
psychopathologies to develop and increase their frequency.
• A liberal attitude towards weapons control may result in more
weapon-related violence or homicidal behaviour
(Westermeyer,1973).
• Cultural permission to consume alcohol freely may increase the
prevalence of drinking problems.
PATHOFACILITATIVE EFFECTS (culture promoting the
frequency of occurrence)

22. • Culture influences how people perceive pathologies and label
disorders, and how they react to them emotionally, and then
guide them in expressing their suffering.
• Faith healing practices in India in cases of major psychiatric
disorders like schizophrenia, bipolar disorders or in OCDS .
People attribute illness as results of “Black magic”.
• Another prevalent misconception in India is that mental
illness is due to the patient ‘not getting married at proper
age’, and that marriage will cure his/her sexual frustration or
problem and there by cure his/her mental illness.
PATHOREACTIVE EFFECTS(culture shaping folk
responses to the clinical condition)

23. • Better prognosis of schizophrenia in developing
countries like India . Although the factors underlying
this result remain insufficiently understood, it has
been speculated that family, social and cultural
factors may have some Pathoreactive effects on
schizophrenia resulting in different prognoses.
(Sartorius et al., 1978)
PATHOREACTIVE EFFECTS(contd.)

24. • Culture-bound or culture-specific syndromes cover an
extensive range of disorders occurring in particular localities
or ethnic groups.
• The behavioral manifestations or subjective experiences
particular to these disorders may or may not correspond to
diagnostic categories in DSM-IV-TR or ICD-10.
• They are usually considered to be illnesses and generally have
local names.
• They also include culturally accepted idioms or explanatory
mechanisms of illness that differ from Western idioms and
outside of their cultural setting.
• Awareness of culture-bound syndromes is important to allow
psychiatrists and physicians to make culturally appropriate
diagnoses and proper treatment.
CULTURE BOUND SYNDROMES

25. CULTURE BOUND SYNDROMES
Name Geographical localization/populations
AMOK
MALAYSIA, INDONESIA, PHILIPPINES, BRUNEI, S
INGAPORE
ATAQUE DE NERVIOS LATINOS
BILIS, CÓLERA LATINOS
BOUFFÉE DÉLIRANTE WEST AFRICA , HAITI
BRAIN FAG WEST AFRICAN
DHAT INDIA
FALLING-OUT, BLACKING OUT SOUTHERN UNITED STATES
GHOST SICKNESS AMERICAN INDIAN
HWA-BYUNG, WOOL-HWA-BYUNG KOREAN
KORO
CHINESE , MALAYSIAN SOUTHEAST
ASIA; ASSAM
LATAH MALAYSIA , INDONESIA

26. CULTURAL PSYCHODYNAMICS
Cultural variables affecting mental
health and mental illnesses

27. • So far the model of transcultural psychiatry has remained at a
phenomenological, descriptive model -in terms of describing either
the so-called culture-bound syndromes, or to the transcultural
differences in the manifestations, course and outcome of the
different illness.
• The need now is to go from the descriptive to explanatory.
• More specifically, it needs to be seen how the transcultural
differences in the personality configurations and psychological
operations can be correlated with the cross-cultural differences in
psychopathology to arrive at an understanding of these.
CULTURAL PSYCHODYNAMICS

28. SIX CULTURAL VARIABLES RELATED TO PSYCHOPATHOLOGY
DEPENDENCY VERSUS AUTONOMY
MATERIAL CULTURE
COGNITIVE STYLE
LINGUISTIC COMPETENCE
SOCIAL SUPPORT SYSTEM
PSYCHOLOGICAL SOPHISTICATION

29. DEPENDENCY VERSUS AUTONOMY
 Interdependence
 Strong sense of identity with
the primary, filial group
 Lesser idea of individuality, of
individual rights and
responsibility
 Greater differentiation
between ‘us’ and ‘them’, with
clearly different codes of
conduct in dealing with these
 Pity, sacrifice, submission and
gratitude as character traits
 “Shame prone society”
 Clearly demarcated ego-
boundaries
Control over one’s
body, action, thoughts and
emotions
Greater self reliance
An acute sense of one’s
rights , duties and
responsibilities
“Guilt prone society’’
TRAITS OF DEPENDENCE PRONE
SOCIETY
TRAITS OF AUTONOMY PRONE
SOCIETY

30. DEPENDENCY VERSUS AUTONOMY
Dependence
Identification with
primary group
Personalized codes of
conduct
Lack of fairness
Highly shame prone
Traditionalism
Indian Personality
Individual centeredness
Compulsivity, pride in
doing a job well. Activity
and work highly valued.
Highly guilt ridden.
Acquisitiveness.
Belief in equality of all.
Belief in individual
freedom.
Western Personality
(Mead,1949;Hsu,1961)

31. • Indian tradition attaches little importance to the
development of a unique, distinctive personality and
to individual self realization” (Hoch,1990)
• “Most patient will approach the doctor with the
expectation of getting advice and guidance…. Very
similar to that.. available from their parents and
family elders”
• Indian patients are brought up with an attitude of
being receptive to such advice and guidance as they
expect a caring, concerned and nurturing attitude
that goes along with the advice in their familial
hierarchical relationships (Roland, 1995)
INDIAN SOCIETY

32. LANGUAGE
• Language "is itself the shaper of ideas, the
programmer and guide for the individual
mental activity’’(Whorf 1961).
• "Language is a determinant of the conception
of reality, a model shaping the mind as well as
a code connecting minds" (Brown 1965).
• It is reasonable to conclude that "the
language and thought of a people develop
together" (Brown and Lennenberg 1954).
LINGUISTIC COMPETENCE

33. • Linguistic “competence" is the speaker - hearer's intrinsic
knowledge of his language and Linguistic “performance" is
the actual use of language in a given situation. (Chomsky,1965)
• Linguistic competence is seen as an innate attribute of
mind, enabling the developing individual to “know" the
grammar or rules of the language of his speech community
after only minimal exposure to it.
• Thus, linguistic competence can be viewed as the tacit
rules of a language specifying the set of sentences that could
occur in the language.
LINGUISTIC COMPETENCE

34. • On the basis of the considerable transcultural differences in
the phenomenology and outcome of mental illness on the
one hand and languages on the other, the two can be inter-
related.
• More specifically, it has been proposed that the linguistic
competence (i.e. the intrinsic ability) importantly determines
the phenomenology of schizophrenia.
• Language seems to be an essential prerequisite for the
manifestations of schizophrenic symptomatology and
outcome of schizophrenia across cultures (World Health
Organization, 1973; 1979) (Varma (1982)
LINGUISTIC COMPETENCE AND
SCHIZOPHRENIA

35. • In the context of schizophrenia, Arieti (1955) has outlined an
innovative, longitudinal view of the mental operations. The
first stage starts from a period of intense
anxiety, panic, confusion and perplexity and culminates in
achievement of psychotic insight.
• Language may take over from the intense anxiety and set into
motion a reverberating cycle, with increasing elaboration of
delusions.
• As the delusions do not fully bind the anxiety, a vicious cycle
results causing the delusion to become more and more
systematized.
LINGUISTIC COMPETENCE AND
SCHIZOPHRENIA(contd.)

36. • In Positive schizophrenics, linguistic competence has positive
correlation with severity of illness and negative correlation
with outcome.
• Greater linguistic competence may take over from intense
anxiety and set into motion a cycle of increasing elaboration
of positive symptoms.
• The positive symptoms may, in turn, cause further anxiety
and excitement, thus, adding to the vicious cycle, thereby
producing more complex and intractable delusions. This may
lead to a severe form of illness and may as well influence
prognosis. (Giridhar C, Kulhara P, Varma V K (1992) Linguistic competence in
positive and negative subtypes of schizophrenia, Indian journal of
psychiatry,34(4),311-320) )
LINGUISTIC COMPETENCE AND
SCHIZOPHRENIA(contd.)

37. • In negative schizophrenics, positive correlation was observed
between outcome and linguistic competence.
• High linguistic competence in a patient with negative
schizophrenia was associated with low degree of negative
symptoms which may have increased chances of recovery.
• Low linguistic competence in a negative schizophrenic
produces high degree of negative symptoms which are not
easily amenable to therapeutic change.
LINGUISTIC COMPETENCE AND
SCHIZOPHRENIA(contd.)

38. • Cognitive styles represent the ways in which the mind
perceives the environment, interprets it and draws
conclusions about it.
• Individuals and cultures differ from each other in cognitive
styles.
• The cognitive style can be characterized as "analytical" at one
extreme and "synthetic " at the other.
Cognitive Styles

39. Cognitive Styles
• Understand a thing or a
phenomenon by breaking it
into parts.
• The Western mind is
classically analytical.
• Prevail in autonomous
oriented society.
• Tries to see things or
phenomena in the totality and
see the relationships between
them.
• The Indian mind is synthetic in
its cognitive style.
• More conducive to the
development of a
unitary, holistic concept.
• Consistent with the
dependence and loose ego-
boundaries in the relationship
of individual with society.
ANALYTICAL STYLE SYNTHETIC STYLE

40. • With increasing transcultural research, the differences across
cultures in the social support system have been correlated
with course and outcome of mental illness.
• The traditional and developing societies which are richer in
social support network have been shown to have a better
prognosis of severe mental illnesses (WHO 1973, 1979)
• A very fruitful area of research in the field of social network
has been that of "expressed emotions".
• Relatives' expressed emotions, especially critical comments
and hostility, have been correlated with adverse prognosis
SOCIAL SUPPORT SYSTEM

41. • Culture consists of the beliefs, values, norms and myths and
the physical environment which is comprised of artifacts like
roads, bridges, buildings, etc. (Al-Issa, 1982).
• It is understandable that the nature of material culture may
influence the psychopathology.
• The same malevolent force may be perceived as a spirit of a
ghost in a developing society and as X-rays and radio waves in
a technologically advanced society. (Varma V K. Cultural
psychodynamics in health and illness. Indian J Psychiatry 1986; 28:177-186)
Material Culture

42. • Psychological sophistication can be perceived as the ability to
see conflicts in intrapsychic terms.
• In other words, the conflict is perceived as within the mind, or
more specifically, between the components of the psychic
structure.
• The conflict cannot be ascribed directly, for example, to social
prohibitions, external authority or malevolent spirits.
• Psychological sophistication may be related to coping
mechanisms and certain types of neuroses, especially hysteria.
• It may also give rise to high introspection as a mental attribute
to understand and resolve conflicts.
Psychological Sophistication

43. • It is possible that the culturally-determined personality
attributes may importantly influence coping mechanisms and
mental illness.
• When faced with emotional conflict, a passive-dependent
person may be likely to more easily "give up”. He may be
more prone to break with reality, develop psychotic coping
behaviour.
• On account of close ties with the society, he can more easily
turn to them to be taken care of.
• He may also develop hysterical and somatoform disorders, so
as to involve other members of the society in its resolution.
CULTURE AND PERSONALITY

44. • On the other hand, an autonomous individual, on account of
his abhorrence of loss of control and rejection of his
dependency needs, may try to resolve his conflicts himself - at
the intrapsychic level.
• He may keep on battling with the anxiety, unbound, or may
convert them into development of neurotic-type distress.
• It is possible that the personality configuration, either
individually or culturally shaped may influence the choice
made.
• The subsequent elaboration and proliferation of the
symptomatology may depend, to a certain degree, upon the
various socio-cultural factors.
CULTURE AND PERSONALITY

45. CULTURAL CONSIDERATION
IN CLINICAL PRACTICE

46. • Culture plays a role in all aspects of mental
health and mental illness.
• So a cultural assessment should be a
component part of every complete psychiatric
assessment.
• The outline for cultural formulation found in
Appendix I of (DSM-IV-TR) is intended to give
clinicians a framework for assessing the role of
culture in psychiatric illness.
CULTURAL FORMULATION

47. ITS PURPOSES ARE:
(1) To enhance the application of DSM-IV-TR diagnostic criteria in
multicultural environments.
(2) To provide a systematic review of the individual's cultural background.
(3) To identify the role of the cultural context in the expression and
evaluation of psychiatric symptoms and dysfunction.
(4) To enable the clinician to systematically describe the patient's cultural
and social reference groups and their relevance to clinical care.
(5) To identify the effect that cultural differences may have on the
relationship between the patient and family and the treating clinician, as
well as how such cultural differences affect the course and the outcome of
treatment provided.
CULTURAL FORMULATION

48. FIVE AREAS OF ASSESSMENT:
(1) Cultural identity of the individual.
(2) Cultural explanations of the individual's illness.
(3) Cultural factors related to psychosocial environment and levels
of functioning.
(4) Cultural elements of the relationship between the individual
and the clinician.
(5) Overall cultural assessment for diagnosis and care.
The outline for cultural formulation

49. CULTURAL IDENTITY refers to the characteristics
shared by a person's cultural group. Identity allows
for a self-definition.
 It includes:
 Ethnic or cultural reference group (including age, socioeconomic
status, religion, relationship status, sexual orientation)
 Degree of involvement in culture of origin.
 Degree of involvement in host culture.
 Aspects of identity that are important to them.
 Migration history (if applicable) – reasons for
migration, losses, trauma, & previous role within family & society.
 Language abilities, use & preferences
Cultural identity

50. Evaluating the cultural identity of the patient helps in
following aspects:
• Identification of potential areas of strengths and supports that may
enhance treatment effectiveness.
• Address the factors that may interfere with the progress of treatment.
• Identification of unresolved cultural conflicts that may be addressed
during treatment.
• Allows the clinician to avoid misconceptions based on inadequate
background information or stereotypes related to race, ethnicity, and
other aspects of cultural identity.
• It assists in building rapport because the clinician is attempting to
understand the individual as a person and not just a representative of the
cultural groups that have shaped the patient's identity.
Cultural identity

51.  The explanatory model of illness is the patient's
understanding of and attempt to explain why he or she
became ill.
 It defines the culturally acceptable means of expression of
the symptoms of the illness, the particular way individuals
within a specific cultural group report symptoms and their
behavioral response to them that are heavily influenced by
cultural values.
The explanatory model of illness includes:
• Patient's beliefs about their prognosis
• Treatment options they would consider.
Cultural Explanations of the Individual's Illness

52.  Difficulties may arise when there are conceptual differences in the
explanatory model of illness between clinician, patient, family, and
community.
 Conflicts between the patient's and the clinician's explanatory models
may lead to diminished rapport or treatment noncompliance.
 Conflicts between the patient's and the family's explanatory models of
illness may result in lack of support from the family and family discord.
 Conflicts between the patient's and the community's explanatory models
could lead to social isolation and stigmatization of the patient.
 Formulation of a collaborative model that is acceptable to both the
clinician and the patient should include an agreed upon set of symptoms
to be treated and an outline of treatment procedures to be used.
Cultural Explanations of the Individual's Illness

53.  An understanding of the patient's family dynamics and
cultural values is integral in assessing the patient's
psychosocial environment. The definition of what constitutes
a family and the roles of individuals in the family differ across
cultures.
 This include:
• Social stressors
• Social supports – role of religion and kin networks, identify
who is a major support for the patient
• Levels of functioning and disability –viewed by
patient, family & community (previous and current)
Cultural Factors Related to Psychosocial
Environment and Level of Functioning

54. • The cultural identity of the clinician and of the mental health team has an
impact on patient care.
• The culture of the mental health care professional influences diagnosis
and treatment.
• Unacknowledged differences between the clinician's and patient's cultural
identity can result in assessment and treatment that is unintentionally
biased and stressful for all.
• Culture influences transference and counter-transference in the clinical
relationship between people seeking psychiatric care and their treating
clinicians.
• When the patient and clinician are of different genders, culturally
ingrained role assumptions may pose difficulties.
Cultural Elements of the Relationship Between
the Individual and the Clinician

55. • The treatment plan should include the use of culturally appropriate
health care and social services.
• Interventions also may be focused on the family and social levels.
• In making a psychiatric diagnosis the clinician should take into
account principles of cultural relativism and not fall prone to
category fallacy.
• Using classification systems such as DSM-IV-TR, developed for one
culture and applying it unquestioningly to another culture where its
relevance may not be comparable.
• Many psychiatric disorders show cross-cultural variation. Objective
evaluation of the multiple possible effects of culture on
psychopathology can be a challenging task for the clinician.
Overall Cultural Assessment for Diagnosis and Care

57. Perspectives that offer great promise for future
research in cultural psychiatry.
(A) Identification of specific fields in general psychiatry that
could be the subject of focused research from a cultural
perspective.
• Topics of epidemiology and neurobiology could be assessed
in this way.
• Epidemiology would address issues primarily in the public
health arena, including stigmatization, racism, and the
process of acculturation.
• A number of cultural variables should be considered in
conducting cultural psychiatry research, including
language, religion, traditions, beliefs, ethics, and gender
orientation.
FUTURE DIRECTIONS AND RESEARCH IN
TRANSCULTURAL PSYCHIATRY

58. (1))CONCEPTUAL ISSUES IN CULTURAL
PSYCHIATRY:
 Universality vs. Distinctiveness of diagnosis
 Evidence-based vs. Value-based approaches
 What are the “diagnosable” features of culture in
psychopathology?
 To what extent does culture apply to
diagnosis/treatment/prognosis?
 Cross-cultural applicability of diagnoses.
FUTURE DIRECTIONS AND RESEARCH IN
TRANSCULTURAL PSYCHIATRY

59. (2)OPERATIONAL ISSUES IN CULTURAL
PSYCHIATRY:
 Elucidation of “normality” and “abnormality”
 Choice of cultural variables.
 Culture in the perception of:
 Severity of symptoms
 Disruption of functionality
 Quality of Life changes
 “Strengths” and “Weaknesses” of an individual patient
 Usefulness of the Cultural Formulation
 Representativeness of cultural/ethnic groups
FUTURE DIRECTIONS AND RESEARCH IN
TRANSCULTURAL PSYCHIATRY

60. (3)Topical Issues in Cultural Psychiatry:
There are five dimensions of the clinical process that are relevant to
research in cultural psychiatry.
These include the consideration of culture as an
 interpretive or explanatory tool of human behavior
 a pathogenic or pathoplastic agent
 a diagnostic and nosological instrument
 a therapeutic or protective factor
 a service or management element.
The basic assumption is that culture impacts each
of these areas, all of which have relevance at
different stages of the clinical encounter between
patient and clinician.
FUTURE DIRECTIONS AND RESEARCH IN
TRANSCULTURAL PSYCHIATRY

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