I’ve always found cultural considerations in psychiatry to be a fascinating but difficult topic to understand. Perhaps this is because the topic is so broad; lessons from one culture may not necessarily be applicable to others. Or perhaps it is because in formal education and exam prep books, there is a lot of focus on abstract, theoretical and conceptual issues. Many questions quiz on specific culture-bound syndromes such as “koro,” “hwabyung,” and “ataque de nervios.” The theme, if any, is usually some variation of: “People have many different viewpoints. Treat all of them with respect.” But usually, big questions remain: How do cultural differences affect, in a concrete, tangible way, the relationship between a psychiatrist and their patient? How does this impact management decisions and outcomes? And how exactly can physicians best communicate with patients who hold views, beliefs, values, and attitudes different from their own?
Well, this book answers those questions.
I recently borrowed this book from one of my attendings. Published by the American Psychiatric Association in 2004, a dozen psychiatrists contributed to the book and illustrated the impact of cultural differences in psychiatrists in different clinical settings with an emphasis on clinical applications.
My favorite part of this book were the clinical vignettes. Each chapter was neatly separated by clinical setting or subspecialty, and included up to 5 clinical vignettes. Memorable examples include a teenage Hispanic female with psychosis; a 6-year-old boy being evaluated for ADHD; a Samoan schoolteacher with psychogenic weakness of the legs. I won’t spoil the conclusions to the cases, but I will reveal that they had numerous twists and turns and that I found them fascinating. Within the book, each case’s cultural components were carefully analyzed and discussed.
I especially liked that the clinical vignettes provided an easily accessible means for classroom discussion. After an initial description of the presenting problem, students could be asked for their ideas in formulating a differential diagnosis. Then the instructor can guide students towards a final diagnosis and provide education. Each case presentation can conclude with a classroom discussion on treatment, management, and communication with the patient in a culturally appropriate manner.
My criticism of the book stems from a personal dislike of repetition. Because the chapters are divided by clinical setting or subspecialty, the same themes are reinforced again, and again, and again. By the sixth chapter or so, I began to tire of seeing the same idea presented in yet another new sentence, and would skim it quickly just until I found another clinical vignette. Please don’t misunderstand me – there were certainly sections of the discussion between cases that were novel and different among the chapters. It was only the sections that were similar that I would not miss.
Would I read the entire book again? Probably not. But would I use it as a reference material for an instructional series? Absolutely.
Tseng, WS, Streltzer, J. Cultural Competence in Clinical Psychiatry. American Psychiatric Publishing, 2004. Print.