Culture in Psychiatric Care

Albert C. Gaw, M.D., D.F.A.P.A.Clinical Professor of Psychiatry

University of CaliforniaSan Francisco

Purposes of Presentation

• To provide a clinically useful definition of culture

• To draw implications for mental health care

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

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

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.

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.

Ethnicity

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

Schermerhorn

Essential Features of Culture

• Culture is learned

• Culture refers to systems of meanings

• Culture acts as a shaping template

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

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.

Association Areas of the Brain

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

Korean Concept

Luke Kim 1993

Hwa-byung

Luke Kim 1993

Components of Culture…

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

Components of Culture…

• 3. Beliefs: Propositions considered to be true.

– The world is round – God is almighty

Components of Culture…

• 4. Values: Ways in which the world is organized into hierarchy of preferences.

– Life > death– Health > illness

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

In Summary

1. Percepts and concepts

2. Propositions

3. Beliefs

4. Values

5. Operational Procedures or

Recipes

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.

Operating Culture

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

Implications for Mental Health Care

• It enhances diagnosis and treatment.

• It fosters clinician’s sensitivity towards patients/clients.

• It enriches psychiatric knowledge.

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.

ReferenceReference

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

Thank you !