A Clinical Manual of Cultural Psychiatry

Abstract

Cultural issues in mental health have long been underrecognized. The 2007 tragedy at Virginia Tech painfully brings forth the need to address these issues. Further, the Accreditation Council for Graduate Medical Education requires residency programs to provide residents with instruction about American culture and subculture. Dr. Russell F. Lim, the director of diversity education and training at the Department of Psychiatry and Behavioral Science at the University of California, Davis, School of Medicine, has edited the Clinical Manual of Cultural Psychiatry, which defines and discusses cultural issues in psychiatry and the application of psychiatry to various ethnic groups in the United States. The text is divided into 3 parts and comprises 7 chapters and 3 appendices. Part I defines an individual's ethnicity as a “sense of belonging to a group of people who have a common set of beliefs and customs (culture) and who share a common history and origin” (p. 7). Part II illustrates the issues of different ethnic groups, mainly African Americans, Asian Americans, Latino Americans, American Indians, and Alaskan Natives. This part explores each group's immigration history (slavery, need for labor or professionals), way of life in the country of origin (traditional) versus that in current American society, and family dynamics including role reversal (like women being the breadwinner), as well as racism, issues in therapy (especially trust) particular to each group, the role of the translator (may interject his or her own views of mental health), each group's perception of symptoms and medications (“too hot or too cold”), and psychopharmacology for each group, among other issues. Part III discusses the differences in metabolism by the cytochrome P450 enzyme system, side effects, and dose requirements in various ethnic groups, especially in reference to antidepressants, antipsychotics, and benzodiazepines. Appendix A is written by psychiatry residents to provide a resident's guide to cultural formulation; Appendix B is a bibliography of topics related to cultural psychiatry, and Appendix C is a glossary of culture-bound syndromes. To summarize, the Clinical Manual of Cultural Psychiatry is a great resource both for clinicians in assessment and treatment of culture-related issues in patients and for training programs in teaching these issues to medical students and residents. Jason Mensah, D.O., Department of Psychiatry, Indiana University School of Medicine, provided with proofreading as well as with clarifying cultural issues discussed in the review. Dr. Mensah reports no financial affiliation or other relationship relevant to the subject of this review.