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Cultural psychiatry ‘Culture’

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culture
‘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.
slide3
Race
  • An alternative view is that the number of alleles that determine visible differences is such a small proportion of the total genetic constitution that the term ‘race’ is inappropriate.
  • When actual allele frequencies are studied in ‘different races’, allele differences are found more often within each group than between groups.
how does ethnicity relate to culture
How does ethnicity relate to culture?
  • Ethnic groups may approximate sufficiently to culture if the sample from which they are drawn contains a self selected cultural group.
  • If ethnicity is to be used as a key variable in research as a class of person its validity as a measure of culture, identity,religion and race must be fully established for the research to be meaningful.
cultural formulation
Cultural formulation

1 Identification of the patient’s culture, including lan-

guage and spiritual/religious affiliation, and multi-

cultural identity;

2 Cultural explanations of the illness (i.e. idioms of

distress, explanatory models, experience with popular

and professional sources of care);

3 Factors related to the psychosocial environment and

functioning (e.g. cultural influences on stressors,

social support and stigma);

4 Cultural aspects of the relationship between patient

and clinician.

college on stolen generation
College on stolen generation
  • May 1997 “Bringing them home” report by Human Rights and Equal Opportunity Commission
  • Removal lead to higher rates of:
    • Ill health
    • Arrest
    • Substance abuse
    • Premature death
  • College apologetic on behalf of profession for not having done more to prevent this
what should services aim for
What should services aim for?
  • Accessible
  • Appropriate
  • Acceptable
interpreters practical considerations
Interpreters: practical considerations
  • Time- interviews usually take twice as long.
  • Seating- TRIANGULAR is the best
  • Take time for introductions
  • Define the nature of the interview
  • Ensure that the language is correct and acceptable
  • Political/religious/cultural differences should not affect the interview.
practical considerations
Practical Considerations
  • Age/ gender of the interpreter can be very important.
  • Confidentiality
  • Interruptions and clarifications
  • Ensure that the interpreter does not give their own technical interpretation
  • Ending the interview
  • Post interview de-briefing with the interpreter
college on atsi mhps
College on ATSI MHPs
  • Paid adequately e.g. because of varied work hours
  • Gender issues addressed
  • Respected as part of multidisciplinary team
  • Research
  • Lack of formal qualifications should not be a barrier
  • Should be able to review own budget allocation
vicarious traumatisation
Vicarious Traumatisation
  • Distress associated with working with victims of extreme trauma
    • Preoccupation and rumination
    • Intrusive imagery
    • Mood disturbance
    • insomnia
    • Changed world view, paranoid perception
slide28

Names and concepts in psychiatry

Malarial treatment of neurosyphilis (NobelPrize)Wagner von Jauregg

Moral treatment; breaking chains in Saltpetriere Pinel (1745-1826)

Primal therapy A. Janov

Psychobiology Adolf Meyer (1866-1950)

Psychodrama J. Moreno

Reciprocal Inhibition Joseph Wolpe

Self-instructional training Meichenbaum

Social Learning Albert Bandura

Sociological theory of suicide Durkheim

Suicide Thomas Browne

The Sick Role Parsons

Therapeutic Community Maxwell Jones

Transactional analysis F. Berne

slide29

Names and concepts in psychiatry

Abnormal Illness Behaviour Pilowsky

Advocated treatment without mechanical

restraints Conolly (1794-1866)

Aggressive and Creative Psychopaths Henderson

Agnosia Term coined by Freud

Alexithymia Nemiah & Sifneos

Anxiety Lewis

Crisis Intervention Linderman (1944), Caplan (1961)

Development of Clozapine Kane

Development of Imipramine Kuhn

Ecological theory of suicide Sainsbury

Gestalt Therapy F. Perls

Hypnotherapy Milton Erikson

Illness Behaviour Mechanic

Interpersonal therapy Sullivan

slide30

Names and concepts in psychiatry

Client-centred therapy: Carl Rogers

Inferiority complex: Alfred Adler

Novelty seeking: Cloninger

Good enough mothering: Donald Winnicot

resource
Resource
  • World's Neurochemistry Portal <http://www.neurochem.org/pages/links_index.htm> - from the International Society for Neurochemistry http://www.neurochem.org/pages/links_index.htmWeb Textbook on Nerve Impulses <http://pb010.anes.ucla.edu/> - with interactive simulations of ions channels (this is an awesome web site)http://pb010.anes.ucla.edu/*Introduction to Neurobiology <http://instruct1.cit.cornell.edu/courses/bionb222/links.htm> http://instruct1.cit.cornell.edu/courses/bionb222/links.htmUS National drug abuse websitehttp://www.drugabuse.gov/NIDAHome.html <http://www.australian-news.com.au/FAS7cm.jpg>