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9 - On the validity and usefulness of existing Eurocentric diagnostic categories
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- By Hilda-Wara Revollo, Universitat Autònoma de Barcelona, Spain, Jorge Atala-Delgado, Anahuac and Chapultepec University, Mexico City, Mexico
- Edited by Kamaldeep Bhui
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- Book:
- Elements of Culture and Mental Health
- Published by:
- Royal College of Psychiatrists
- Published online:
- 25 February 2017, pp 42-46
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- Chapter
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Summary
‘[I]t is clear that there is no classification of the Universe not being arbitrary and full of conjectures. The reason for this is very simple: we do not know what thing the universe is.’
(Borges, 1993)The principal mental health diagnostic classifications are found in the International Classification of Diseases (ICD) of the World Health Organization (www.who.int/classifications/icd/en) and the Diagnostic and Statistical Manual of Mental Disorders (DSM) of the American Psychiatric Association (www.psych.org/practice/dsm). The DSM was initially developed to create a common system of nomenclature, and the objective of subsequent iterations was the identification of maximally valid diagnostic criteria according to a specific classificatory system. Both the DSM and the ICD systems (despite the ostensible international focus of the latter) are fundamentally based in European and North American thinking (Kleinman, 1988). Western diagnostic systems can be understood in the way that structural anthropology conceptualises scientific classification: ‘classificatory schemes […] allow the natural and social universe to be grasped as an organized whole’ (Levi-Strauss, 1966: p. 135).
As a manner of observing the universe, classifications of mental disorders are necessarily immersed in a culture-specific context, which clearly complicates the possibility of their universal application (Heidegger, 2000). Growing multiculturalism demands questioning of the pertinence of these classification systems in non-Western environments. The consequences of generalising data derived from these systems is itself questionable and requires attention (Beneduce, 2006). Three epistemological positions can be distinguished in relation to the question of the validity and/or usefulness of Western diagnostic systems for individuals from non-Western cultures:
• a universally applicable approach, from which the DSM and ICD criteria were born
• a culture-specific approach, in which diagnostic criteria would be developed relative to each culture
• a classification-free approach, which questions the coherence and justification of diagnostic classifications, Western or otherwise.
Classification as universally applicable
The first approach is the most common and shared by mainstream psychiatry. The DSM represents one of the best known systems for the universalisation of psychiatric entities to other cultures (Kupfer et al, 2008; Yeung & Kam, 2008).
8 - Necessary and sufficient competencies for intercultural work
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- By Hilda-Wara Revollo, Universitat Autònoma de Barcelona, Spain
- Edited by Kamaldeep Bhui
-
- Book:
- Elements of Culture and Mental Health
- Published by:
- Royal College of Psychiatrists
- Published online:
- 25 February 2017, pp 36-41
-
- Chapter
- Export citation
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Summary
‘Over and over again it has been necessary to learn the lesson that the observer influences the observed. In the field of mental health, we have not only to reckon with the natural effect of the observers’ own bias but we also have to deal with a second variable: the effect of this bias on the patient.’
(Jackson, 1960: pp. 5–6)Intercultural work has converted into a daily reality the challenges of demographic change taking place all over the world (International Organization for Migration, 2012). Professionals who work in intercultural contexts are inevitably affected by the experiences and perceptions of patients from different cultures, and this can place a strain on their professional role (Smedley et al, 2002; Qureshi & Collazos, 2005; de Leon Siantz, 2008; Engebretson et al, 2008; Clark, 2009; Blume & Lovato, 2010). Mental healthcare professionals continue to raise questions about the sort of knowledge and skills base that contribute most to effective and sensitive intercultural work (Cunningham et al, 2002; Kumagai & Lypson, 2009; Ben-Ari & Strier, 2010; Mian et al, 2010):
• What sorts of adjustments should one make to meet the needs of a patient from a different culture?
• Beyond linguistic difficulties, manageable with the participation of a medical interpreter or intercultural mediator (see Chapter 11, this volume), what should the clinician keep in mind in order to adequately attend to the patient?
• How can cultural knowledge be applied effectively rather than get in the way?
• What abilities is it most useful to develop?
• Can they be applied to all patients from the same ethnic group?
• Which attitudes facilitate the creation of a therapeutic space and effectiveness in intercultural work? Should the clinician directly raise the matter of clinician–patient differences (race, ethnicity, etc.), or is it better to wait for the patient to take the initiative?
• How can clinicians develop their cultural competence without losing their personal professional style, which is founded on their own professional and cultural background?
8 - Necessary and sufficient competencies for intercultural work
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- By Hilda-Wara Revollo, Psychologist, Servei de Psiquiatriá, Hospital Universitari Vall d'ebron, and Doctoral Candidate, Universitat Autònoma de Barcelona, Spain
- Edited by Kamaldeep Bhui
-
- Book:
- Elements of Culture and Mental Health
- Published online:
- 01 January 2018
- Print publication:
- 01 January 2013, pp 36-41
-
- Chapter
- Export citation
-
Summary
‘Over and over again it has been necessary to learn the lesson that the observer influences the observed. In the field of mental health, we have not only to reckon with the natural effect of the observers’ own bias but we also have to deal with a second variable: the effect of this bias on the patient.’
(Jackson, 1960: pp. 5–6)Intercultural work has converted into a daily reality the challenges of demographic change taking place all over the world (International Organization for Migration, 2012). Professionals who work in intercultural contexts are inevitably affected by the experiences and perceptions of patients from different cultures, and this can place a strain on their professional role (Smedley et al, 2002; Qureshi & Collazos, 2005; de Leon Siantz, 2008; Engebretson et al, 2008; Clark, 2009; Blume & Lovato, 2010). Mental healthcare professionals continue to raise questions about the sort of knowledge and skills base that contribute most to effective and sensitive intercultural work (Cunningham et al, 2002; Kumagai & Lypson, 2009; Ben-Ari & Strier, 2010; Mian et al, 2010):
• What sorts of adjustments should one make to meet the needs of a patient from a different culture?
• Beyond linguistic difficulties, manageable with the participation of a medical interpreter or intercultural mediator (see Chapter 11, this volume), what should the clinician keep in mind in order to adequately attend to the patient?
• How can cultural knowledge be applied effectively rather than get in the way?
• What abilities is it most useful to develop?
• Can they be applied to all patients from the same ethnic group?
• Which attitudes facilitate the creation of a therapeutic space and effectiveness in intercultural work? Should the clinician directly raise the matter of clinician–patient differences (race, ethnicity, etc.), or is it better to wait for the patient to take the initiative?
• How can clinicians develop their cultural competence without losing their personal professional style, which is founded on their own professional and cultural background?
Many institutions have published position statements, teaching materials and literature promoting cultural competence.
9 - On the validity and usefulness of existing Eurocentric diagnostic categories
-
- By Hilda-Wara Revollo, Psychologist, Servei de Psiquiatriá, Hospital Universitari Vall d'ebron, and Doctoral Candidate, Universitat Autònoma de Barcelona, Spain, Jorge Atala-Delgado, Psychologist and Anthropologist, Anahuac and Chapultepec University, Mexico City, Mexico
- Edited by Kamaldeep Bhui
-
- Book:
- Elements of Culture and Mental Health
- Published online:
- 01 January 2018
- Print publication:
- 01 January 2013, pp 42-46
-
- Chapter
- Export citation
-
Summary
‘[I]t is clear that there is no classification of the Universe not being arbitrary and full of conjectures. The reason for this is very simple: we do not know what thing the universe is.’
(Borges, 1993)The principal mental health diagnostic classifications are found in the International Classification of Diseases (ICD) of the World Health Organization (www.who.int/classifications/icd/en) and the Diagnostic and Statistical Manual of Mental Disorders (DSM) of the American Psychiatric Association (www.psych.org/practice/dsm). The DSM was initially developed to create a common system of nomenclature, and the objective of subsequent iterations was the identification of maximally valid diagnostic criteria according to a specific classificatory system. Both the DSM and the ICD systems (despite the ostensible international focus of the latter) are fundamentally based in European and North American thinking (Kleinman, 1988). Western diagnostic systems can be understood in the way that structural anthropology conceptualises scientific classification: ‘classificatory schemes […] allow the natural and social universe to be grasped as an organized whole’ (Levi-Strauss, 1966: p. 135).
As a manner of observing the universe, classifications of mental disorders are necessarily immersed in a culture-specific context, which clearly complicates the possibility of their universal application (Heidegger, 2000). Growing multiculturalism demands questioning of the pertinence of these classification systems in non-Western environments. The consequences of generalising data derived from these systems is itself questionable and requires attention (Beneduce, 2006). Three epistemological positions can be distinguished in relation to the question of the validity and/or usefulness of Western diagnostic systems for individuals from non-Western cultures:
• a universally applicable approach, from which the DSM and ICD criteria were born
• a culture-specific approach, in which diagnostic criteria would be developed relative to each culture
• a classification-free approach, which questions the coherence and justification of diagnostic classifications, Western or otherwise.
Classification as universally applicable
The first approach is the most common and shared by mainstream psychiatry. The DSM represents one of the best known systems for the universalisation of psychiatric entities to other cultures (Kupfer et al, 2008; Yeung & Kam, 2008).
Contributors
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- By Mohamed Agoub, Morton Beiser, Dinesh Bhugra, Kamaldeep Bhui, Tamsin Black, Miguel Casas, Prabha S. Chandra, Andrew Cheng, Francisco Collazos, Tom K. J. Craig, Nisha Dogra, Alexander Friedmann, Susham Gupta, Jannat el Harrak, David Holzer, Karen Iley, David Ingleby, Peter B. Jones, Gurvinder Kalra, Karim Khalid, James B. Kirkbride, I-Chao Liu, Carol Maggi, María del Mar Ramos, Driss Moussaoui, Priyadarshini Natarajan, James Nazroo, Man Kin Ng Roger, Norman Poole, Adil Qureshi, Hilda-Wara Revollo, Pablo Ronzoni, Pedro Ruiz, Ajit Shah, Laura Simich, Daya Somasundaram, Thomas Stompe, Rachel Tribe, Turner Stephen, Cristina Visiers, Wojteck Wojcik, Anna Yusim
- Edited by Dinesh Bhugra, Susham Gupta
-
- Book:
- Migration and Mental Health
- Published online:
- 04 February 2011
- Print publication:
- 02 December 2010, pp xii-xvi
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Chapter 19 - Intercultural mediation:
- from Section 4 - Management, services and training
- Edited by Dinesh Bhugra, Susham Gupta
-
- Book:
- Migration and Mental Health
- Published online:
- 04 February 2011
- Print publication:
- 02 December 2010, pp 245-260
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- Chapter
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Summary
One of the key factors in the process of migration is what the individuals carry with them and what they leave behind. Following the process of migration and then settling down in the new society, the individual may experience cultural bereavement, culture shock or culture conflict. Although grief is often associated with loss, the notion of cultural bereavement arises from an understanding of losses incurred and related to cultural values. This chapter describes in brief various theories related to bereavement. To understand culture shock and culture conflict, the role of acculturation and the processes related to it become very important. Acculturation is seen as the process in which individuals and groups from different cultures come into continuous contact with another culture. Racial and cultural congruity become important in understanding where an individual settles down and what kind of response they and their group generate amongs the larger society.