30 - Culture and Psychiatric Service

Abstract

This chapter focuses on various social and cultural factors that influence the practice of psychiatric service in general. While increased knowledge and improvements in clinical care for the mentally ill are changing peoples' attitudes toward mental disorders, there are broad differences in attitudes toward mental patients cross-culturally. Another factor that may implicitly or explicitly influence the practice of psychiatry is the folk or traditional medical knowledge of patients. If patients and psychiatrists have different racial backgrounds and there has historically been a negative relationship between them, there is a potential for racism even in clinical settings. Another factor that influences the mode of clinical practice is payment for medical service. Very closely related to cultural matters are the kinds of medical services for which patients can be charged and how much they can be charged. In societies where "talking therapy" is not highly valued, it is difficult to charge patients very much for the service, which discourages psychiatrists from performing this time-consuming therapy. The practice of general psychiatry is strongly embedded in the medical culture that develops within the medical system. Most physicians and medical staff living within this invisible cultural system, while unaware of it, are influenced and regulated by it. The value systems, and political patterns, the basic concern for individual human rights varies affects the mode of psychiatric practice both directly and indirectly. Whether patients can be forced to be hospitalized or need voluntary consent, whether patients can be physically constrained when their behavior becomes disturbing, or forced to take medications or receive injections are issues of practice that are dealt with differently in various societies, depending on how the culture, the legal system, and administrative rules regard such practices.